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1 Please provide name of the business that the complaint relates to.

1.1 Please specify:


2 How are you associated with the company?

Employee
Director
Vendor/supplier
Other

2.1 Please specify:

3 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
I would like to remain anonymous

3.1 Name:
3.2 Contact number:

4 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
Bribery and corruption
Concurrent employment
Conflict of interest
Discrimination
Harassment of any nature (other than sexual harassment)
Inappropriate use of social media
Incorrect financial reporting
Insider trading
Misappropriation of company assets/resources
Mishandling of confidential information
Procurement fraud
Sexual harassment
Tax fraud
Victimisation or bullying
Violation of the environment health and safety guidelines
Others

4.1 Please specify:

5 Please provide name, designation and department of the person(s) involved?

Name Designation Department
Individual 1
Individual 2
Individual 3
Individual 4

6 When did the incident occur?

(Please provide tentative date if you do not know the exact date)

7 Please confirm the location of the incident

8 How did you find out about this incident?

9 How long has this been occurring for?

Less than a month
1 - 6 months
6 - 12 months
Greater than 12 months

9.1 Please specify:

10 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.

11 Do you have any evidence in support of your allegations?

Yes
No

11.1 If yes, please provide details of the evidence:
11.2 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)

12 Is anyone else aware of this incident?

Yes
No
Name Designation Department
Individual 1
Individual 2
Individual 3
Individual 4

13 Is there any additional information that would facilitate the investigation of this matter?

Yes
No

13.1 If yes, please provide detail:

14 Have you reported this incident to anyone in the company?

Yes
No

Name Designation Date
Individual 1
Individual 2
Individual 3
Individual 4

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 200 8301
Fax Dial 1800 200 8301 and select option 2 on IVR
Email arvind@ethicshelpline.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

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