Appendix G – Supervisor Notification Form
| No: 44021528 | Date(g): 11/10/2022 | Date(h): 16/3/1444 |
Effective from Oct 11 2022 - Oct 10 2022
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Fraud Supervisory Notification
A submission to the manager of SAMA General Department of Cyber Risk Control.
The Saudi Central Bank (SAMA) requires immediate notification of new fraud typologies and significant fraud incidents to mitigate the risk of the fraud impacting additional customers, other organisations, or the financial sector in the KSA. This form should be used to provide the notification. Please note that all required information must be provided, however it is understood that not all information may be available at the time of notification. Where information is not available at the time of notification, any gaps should be supplied to SAMA promptly as the investigation progresses.
Notifier Information
| NOTIFIER’S SIGNATURE* | NOTIFIER’S POSITION* | DATE* |
| NOTIFIER’S NAME* | MEMBER ORGANISATION OF NOTIFIER* | |
| FRAUD NOTIFICATION TYPE* | DATE OF INCIDENT* | |
| ☐ New typology | ☐ Significant internal fraud | |
| ☐ Significant external fraud | ☐ Significant accounting irregularity | |
| ☐ Wholesale Payment Endpoint Security Fraud | ||
| ORIGIN OF THE INCIDENT*: | ||
| METHODS USED*: | ||
| RELATED PARTIES (INTERNAL AND EXTERNAL)*: | ||
| OUTCOME (INCLUDING LOSSES WHERE APPLICABLE)*: | ||
| CORRECTIVE ACTIONS*: | ||
| ADDITIONAL INFORMATION: | ||
* Denotes required fields