Whistleblower reporting form for reporting violations

*Required fields

1. Company concerned and Reporter details

 

Provide Reporter details

2. Contact details of the Reporter

Mailing address

3. Data of entities concerned by the report

Please provide data depending on whether it is a natural person, legal entity, or organizational unit without legal personality, which the law grants legal capacity

 

First name and last name of the natural person concerned by the report / Name of the company concerned by the report.

4. Description of violations

Please indicate the type of violation

 

Time frame - Date of violation occurrence

5. Statements of the Reporter

 

I declare that: