WHISTLEBLOWING BREACH REPORT

Provided in accordance with the Whistleblowing Law of the Republic of Lithuania/Latvia/Estonia

Breach form

Provided in accordance with this Procedure*

Date(Required)

Location(Required)

Details of the person reporting the breach

Full name

Personal code

Workplace (employment or contractual relationship with the Company, internship)

Position title

Telephone number (contact details)

Personal email or residential address

Information on a breach

What breach are you reporting? What kind of breach is it? Please provide description of the violation by providing particular facts.

Who committed this breach? What might have been the motive for the person (s) committing the breach?

Date, time, place of the breach.

Details of the person or persons committing the breach

Full name

Workplace

Position title

Are there any other persons who were or could have been involved in the breach? If yes, specify who they are.

Details of the witness or witnesses to the breach

Full name

Workplace

Position title

Tel.

E-mail

Are there any other witnesses to the breach? If yes, provide their contact details.

When was the breach committed and when did you become aware of it or notice it?

What data could you provide in support of the breach, which could assist in the examination of the breach? Please provide any accompanying written or other evidence of the breach

Have you already reported this breach to anyone? If you have reported, who was informed, and did you receive a reply? If you have received a reply, please state the substance of the reply (attached).

Applicable only in Latvia, additionally: Do you wish to receive a confirmation of the receipt of the report and the decision to recognise or not recognise the submission as a whistleblower's report?

Other observations and comments.

File

Drop files here or

Max. file size: 20 MB.

Consent(Required)

I confirm that I am aware of the legal consequences for providing false information and that the information I provide is true and correct.

WHISTLEBLOWING BREACH REPORT

Breach form

Provided in accordance with this Procedure*

Details of the person reporting the breach

Information on a breach

Details of the person or persons committing the breach

Details of the witness or witnesses to the breach

Obligātās sīkdatnes

Statistikas sīkdatnes