Fraud Report Questionnaire

We thank you for reporting the suspected fraud. Nkonki would like to guarantee your ANONYMITY. This is in compliance with Protected Disclosures Act of 2001. In terms of this Act,

• the employee has a responsibility to disclose Criminal/Irregular conduct;
• the employer has a responsibility to protect the Whistle Blower; and
• any action taken against the Whistle blower by the Employer amounts to Occupational Detriment.

In order to pursue the reported matter, please provide us with the following details:

Name of The Company Where Fraud is commited:
Describe in detail,the nature of fraud/irregularity:	Type here....
Frequency of the suspected fraud/irregularity:
The date and/or time on which fraud/irregularity took place:
The location where fraud/irregularity took place:
Name and surname of the suspect(s)?:
Position of the suspect in the company:
Department / Division in which the suspect(s) works:
Other external parties involved (e.g. Suppliers):
If available,pease provide name of the supplier:
Name of the suspect within the external company/supplier:
Any other specific information you would like to provide:	Type here....
Your contact details (We would like to once again guarantee you anonymity and full protection of your identity):
This information is needed solely for the purposes of requesting additional information should there be a need. However, if you are not comfortable and you feel you have given us enough details we would understand.

For any documents or evidence you would like to submit:

• Fax: 086 527 7294
• Email: fraudhotline@nkonki.com

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