Tip-offs - agribusiness certification company in kenya,AfriCert Ltd

WHISTLEBLOWER DISCLOSURE FORM
Please provide the following details for any suspected case of improper conduct or any such breach or suspected breach of law or regulation that may adversely impact the company. You may be called upon to assist in the investigation if deemed appropriate.

WHISTLEBLOWER CONTACT DETAILS
SUSPECT'S DETAILS
WITNESS(ES) DETAILS

WHISTLEBLOWER DISCLOSURE DETAILS (Optional if you wish to remain anonymous)

Name

Phone Number

E-Mail Address

SUSPECT'S DETAILS

Name

Designation/Title

Department

Phone Number

E-Mail Address

WITNESS(ES) DETAILS (if any)

Name

Designation/Title

Department

Phone Number

E-Mail Address

COMPLAINT: Briefly describe the improper conduct and how you knew about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.

1. Kindly explain the improper conduct

2. Which policy position or legal/statutory provision was breached by this conduct?

3. When did it happen and when did you notice it?

4. Where did it happen?

5. Is there any evidence that you could share?

Choose a file

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6. Are there any other parties involved other than the suspect stated above?

7. Have you reported to any law enforcement agency?

8. Do you have any other details or information which would assist us in the investigation?

WHISTLEBLOWER DISCLOSURE DETAILS (Optional if you wish to remain anonymous)

Name

Phone Number

E-Mail Address

SUSPECT'S DETAILS

Name

Designation/Title

Department

Phone Number

E-Mail Address

WITNESS(ES) DETAILS (if any)

Name

Designation/Title

Department

Phone Number

E-Mail Address

COMPLAINT: Briefly describe the improper conduct and how you knew about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.

1. Kindly explain the improper conduct

2. Which policy position or legal/statutory provision was breached by this conduct?

3. When did it happen and when did you notice it?

4. Where did it happen?

5. Is there any evidence that you could share?

6. Are there any other parties involved other than the suspect stated above?

7. Have you reported to any law enforcement agency?

8. Do you have any other details or information which would assist us in the investigation?

9. Any other comments:

Date:

Signature: