SygnalistaOnline: Form notification

Reporter's details

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First name*

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Last name*

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The nature of the connection with the organization*

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Correspondence address

Content of the report

Guidelines for report content

Describe in detail your suspicions and the circumstances of their occurrence according to the knowledge you possess. Please include, among others:
1) the date and place of the occurrence of the irregularity (or the date and place of obtaining information about the irregularity),
2) a description of the specific situation or circumstances that create the possibility of the irregularity,
3) information about persons who committed irregularities,
4) all evidence and information that may be helpful in the process of reviewing the irregularity.

Describe in detail your suspicions and the circumstances of their occurrence according to the knowledge you possess.*

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Data of the persons concerned by the report

Indicate all persons concerned by the report and their contact details

Witnesses to irregularities

Indicate witnesses of irregularities and their contact details

Attachments and evidence in the case

Files extension: jpg, png, pdf, mp3. Maximum 10 MB. Attention! Metadata is not removed from MPEG files.

Whether irregularities have been reported to another authority/whether an external report has been made?

Describe the situation, specifying the recipients of the reports

Statement

I declare that by submitting this notification:

I act in good faith,
I have reasonable belief that the allegations contained in the disclosed information are true,
I am not disclosing for profit,
The disclosed information is consistent with my knowledge and I have disclosed all facts and circumstances known to me regarding the subject of the report,
I am familiar with the PIEKARNIA BIAŁOGON JACEK IWANOWSKI procedure for reporting cases of irregularities and protecting persons making reports.

Important documents

Confirm that you have read the document by checking the appropriate checkbox. Fields with an asterisk (*) are mandatory and required.