1 How are you
associated with the company?
Employee
Vendor/supplier
Director
Other
2 Your details:
I
would like to share my name and contact information
I
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
Child labour
Claiming of false expenses in reimbursement
Concurrent employment
Conflict of interest
Discrimination
Favouritism
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
Procurement fraud
Sexual harassment
Substance abuse
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
Others
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?
Less
than a month
1
- 6 months
6
- 12 months
Greater
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?
Yes
No
10.1 If yes, please provide details of the
evidence:
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?
Yes
No
12 Is there any
additional information that would facilitate the
investigation of this matter?
Yes
No
12.1 If yes, please provide detail:
13 Have you reported
this incident to anyone in the company?
Yes
No
Please send a copy of the complaint to my email address
You can also report the matter through following reporting channels
| Reporting Channels |
Contact Details |
| Phone |
1800 103 0275 |
| Fax |
Dial 1800 103 0275 and select option 2 on IVR |
| Email |
ask@ethicshelpline.co.in |
| Post Box |
P. O. Box No 71, Sub Post Office, Plot No. D, 6/14, DLF Qutub Enclave, DLF Phase 1, Gurgaon - 122002, Haryana, India |
Legal |
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a member firm of the KPMG network of independent
member firms affiliated with KPMG International
Cooperative ("KPMG International"), a Swiss entity.
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