Crime Prevention Form

1Whistleblower Information

2Type of Offense to Report

3Individuals Involved

4Description of the Incident

5Location of the Incident

6Date and Time of the Incident

7Available Evidence

8Additional Information

Do you wish to remain anonymous?

Yes

Name(Required)

Position/job title

Email(Required)

Phone

Relationship with the organization or company involved

What type of offense do you suspect or believe may have been committed?

Tipo de delito

Bribery

Private sector corruption

Money laundering

Document forgery

Embezzlement of funds

Other (please specify)

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Who is/are the individual(s) involved in the alleged offense?

Full Name(s)

Company or Organization (if applicable)

Job Title/Position

Do you know the relationship of the individuals involved with the organization or company?

Relación de personas involucradas

Employee

Contractor

Client

Supplier

Community Member

Other (please specify)

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How did you learn about the incident?

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Describe the incident in which you suspect a crime may have been committed. Include details about what happened, how it occurred, and when.

Cómo supo del incidente

I witnessed it personally

I was informed by a third party

Other (please explain):

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Where did the incident occur?

City

Address or specific location (if known)

When did the alleged crime occur?

Date

DD slash MM slash YYYY

Time (approximate if not known exactly)

Has the incident happened more than once?

El incidente ha ocurrido más de una vez

Yes

Not sure

Is there any other relevant information you would like to share?

El incidente ha ocurrido más de una vez

Yes

Not sure

If you wish, you may attach additional information such as images, photographs, or videos. Allowed formats: jpg, png, doc, docx, xls, xlsx, pdf, ppt, pptx, avi, mp4, mov, mp3.

File

Drop files here or

Max. file size: 100 MB.

Do you have any evidence to support the report? For example, emails, documents, photographs, recordings, or other materials.

Otros

Note: All information provided will be treated confidentially, and measures will be taken to protect the identity of the reporting person, in accordance with current regulations.

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Crime Prevention Form

Santiago

Coquimbo

La Higuera

Contact