Whistleblower reporting form for reporting violations

* Required fields

1. Company affected by the violation and Reporter's information

Enter the submitter's information

2. Contact information for the reporter

Mailing address

3. Information about the entities covered by the notification

Please provide the relevant information depending on whether the entity is a natural person, a legal entity, or an organizational unit without legal personality to which the law grants legal capacity

 

First and last name of the natural person covered by the notification / Name of the company covered by the notification.

4. Description of violations

Please select the type of violation

Time period - Date of the violation

5. Declarations by the Applicant

 

I hereby declare that: