English Form

1. Who is/was engaged in the possible act(s) of misconduct? Provide name, title and any other relevant details.

First Name:

Last Name:

Title:

2. What happened? Please provide the details of the possible misconduct. Be as precise as possible.

Additional Information:

3. When was the possible misconduct committed?

4. Where was the possible misconduct committed?

Describe the location:

5. How was the possible misconduct perpetrated? For example, were any checks, procedures or safeguards circumvented or violated to carry out the act(s)?

6. To your knowledge, WHY were the act(s) undertaken by the person who allegedly committed the misconduct?

7. Is there any specific evidence (e.g. documentation, witnesses) that you are aware of and how can they be located or contacted??

8. Please provide the contact details for ENERGY VISION to contact you:

I prefer to remain anonymous, understanding that ENERGY VISION may not be able to obtain additional details from me or pursue appropriate action on the matter due to my anonymity.

First Name:

Last Name:

Address:

Country:

Cellular Phone:

Email: