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Reporting form
Personal data (optional)
First and last name
E-mail address
Phone number
How do you relate to our company?
Employee
Applicant
Customer / Client
Interested party
Service provider
No direct relation
Information on the incident
Subject
*
Description
*
When did the incident occur?
*
in the last 7 days
in the last 2 - 4 weeks
in the last 3 months
in the last 6 months
more than 6 months ago
Did you notice the incident yourself?
*
Yes
No
Please confirm the accuracy of your information.
*
Submit
Fields marked with
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are required.