Bribery Complaint Report Form

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Bribery Complaint Report Form

Bribery Complaint Report

Type of Complaint

Bribery

Illegal Levies

Gratification

Extortion

Day / Date

Delivered Via

Direct

Complaint Box

Letter

Telp. (021 8193582)

Whistleblowing System

Email

Addressed to

FKAP

Legal

Auditor Internal

Name of Employee Reported

Problems in the Work Area

Headquarters

Branch office

Project

a. The problem complained about (the main points of the complaint expressed and the amount of loss)

b. Parties involved (who are the responsible parties including witnesses)

c. Location of the incident (specific location of the incident)

d. Time of incident (Describe day, date, time, during/after working hours)

e. Tell the chronology of events and the evidence

f. Has this incident happened before? If YES, provide an explanation

I agree and am correct in approving this reporting

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CONTACT INFO

PT. Nusa Raya Cipta Tbk
Gedung Graha CIpta
Jl. D.I. Panjaitan No. 40
Jakarta Timur , 13350

PHONE AND FAX. INFO

Phone : (021) 8193526 ( 3 lines )
               (021) 819 35 82 ( 3 lines )
               (021) 819 35 08
Fax.      : (021) 819 34 71
                (021) 819 35 44

EMAIL AND WEBSITE INFO

Email : nrc@nusarayacipta.com
corsec@nusarayacipta.com
hrd@nusarayacipta.com
Website : nusarayacipta.com

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