Whistleblowing Declaration Form

Do you wish to remain anonymous?

If you want us to know your identity, please complete your contact details below:

Name:

Phone number:

E-mail Address:

Please notice that we will protect your identity if you wish to stay anonymous. Not having the possibility to communicate with you may limit our ability to investigate your concern.

Please tell us where the incident occurred:
(please specify the country, entity, branch, city, department, ..)

Please tell us where the incident occurred:

Please tell us when the incident occurred:

Please describe the illegal, unethical or improper conduct you want to report as
detailed as possible:
(please attach all documents (or name their location) that can help us to investigate your report,
please identify the persons or organizations engaged in the behavior by name)

Please describe the illegal, unethical or improper conduct you want to report as

Please tell us how and when you became aware of the incident and what your relation to Arval is :

Please identify the names of the persons or organizations to whom you might have already reported:

Please state the assumed damage amount, the incident might have caused in EUR:
(only to be filled should you have any information or idea about the potential damage)

state the assumed damage amount, the incident might have caused in EUR:

Do you believe that somebody has tried to conceal the reported behavior or issue?
(please identify the person(s) by name and explain what actions were taken to conceal it)

Do you believe that somebody has tried to conceal the reported behavior or issue?

Do you allow us to contact you in case of additional questions?

By phone (as stated in the contact details)

By E-mail (as stated in the contact details)

Please be assured that we will not contact you on your company phone number or company e-mail address if not stated in the contact details above. Please tell us the best time for communication (with your contact details) should you want us to call you on a private telephone number.

Please read your statement carefully before sending it to us. We keep the provided information strictly confidential as described in the Ethics Alert Procedure.

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