1 How are you
associated with the company?
2 Your details:
would like to share my name and contact information
would like to share my information with KPMG, but
not with the company
3 Please select the applicable incident
type(s) from the list below that best describes
the issue(s) you are reporting. Please note that
multiple issues can be selected
Acceptance of gifts and entertainment
Acceptance of kickbacks
Breach of Company policies
Bribery and corruption
Claiming of false expenses in reimbursement
Conflict of interest
Financial fraud of any nature
Fraud in request for proposal or request for quotation
Harassment of any nature other than sexual harassment
Inappropriate use of social media
Misappropriation of Company assets or resources
Misuse of Company confidential information
Misrepresentation of Company’s financial books and records
Misuse of Company name or logo
Misuse of authority
Unfair trade practices and/ or anti-competitive behaviour
Victimization or bullying
Violation of any laws or regulations applicable to the Company
Violation of human rights
Violation of the environment, health and safety guidelines
4 Please provide name, designation and
department of the person(s) involved?
5 When did the incident occur?
(Please provide tentative date if you do not know
the exact date)
6 Please confirm the location of the incident
7 How did you find out about this incident?
8 How long has
this been occurring for?
than a month
- 6 months
- 12 months
than 12 months
9 Please provide a detailed description
of the incident. To enable your company to act on
your complaint, you are requested to provide specific
information where possible including names, location,
date, time etc. Please note that this field is limited
to 5,000 characters.
10 Do you have
any evidence in support of your allegations?
10.1 If yes, please provide details of the
10.2 Please attach the evidence:
(Maximum file size is 500 KB)
(Allowed files - .zip, .doc, .docx,
.pdf, .jpg, .png)
(Please zip the files for multiple attachments)
11 Is anyone else aware
of this incident?
12 Is there any
additional information that would facilitate the
investigation of this matter?
12.1 If yes, please provide detail:
13 Have you reported
this incident to anyone in the company?
Please send a copy of complaint to my email
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