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Whistleblowing
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Whistleblowing
SECTION A: Personal Details of Reporter
Name
*
Designation
Department
Email Address
Phone
Do you wish to remain anonymous?
*
Yes
No
Are you willing to be contacted for further clarification if necessary?
*
Yes
No
SECTION B: Incident Details
Type of Misconduct
Detailed Description of the Incident
Date of Incident
Location of Incident
Persons Involved:
Role
Persons Involved
Role
Are there any witnesses?
Yes
No
SECTION C: Evidence or Supporting Documentation
Do you have any evidence or supporting documents?
Yes, I have Supporting Documents.
No, I do not have any Supporting Documents.
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What is the nature of this supporting document(s)?
Emails or written correspondence
Screenshots or images
Audio or video recordings
Financial documents (e.g., invoices, receipts, account statements)
Internal reports or memos
Witness statements
Contracts or agreements
Do you believe there are other documents that others may have access to?
Yes
No
If yes, please list:
Role
Role
Kindly attach or include all supporting documents when submitting this form. These documents will greatly assist in the fair and thorough investigation of your report. Please ensure that all files are clearly labeled and relevant to the issue reported.
DECLARATION
I affirm that the information provided is accurate to the best of my knowledge. I understand that this form will be treated with strict confidentiality.
Full Name
Signature
Date
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