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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
I would like to remain anonymous

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
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 or resources
Mishandling of confidential information
Misuse of authority
Procurement fraud
Sexual harassment
Tax fraud
Victimization or bullying
Violation of the environment - health and safety
Others

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

Name Designation Department
Individual 1
Individual 2
Individual 3
Individual 4

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

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

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

Yes
No

Please send a copy of complaint to my email address

You can also report the matter through following reporting channels

Reporting Channels Contact Details
Phone 1800 200 9350
Fax Dial 1800 200 9350 and select option 2 on IVR
Email trent@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

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