Whistleblowing / consulting by email

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〇Please tell us about yourself

[Required] Company Name:

[Optional] Department:

[Required] Disclosure of your name to the company: Make it anonymous / Use your real name (Name: 　　　　　　 )

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〇Please give us your contact information (That will not be disclosed to the company)

[Required] Disclosure of your name to the external contact: Make it anonymous / Use your real name (Name: 　　　　　　)

[Required] Email address:
*A notification of acceptance will be sent to the email address you entered.

[Required] Whether the results of the investigation should be sent or not: Necessary / Unnecessary
*If you need to be contacted about the results of the investigation, please choose one of the following means of communication.
　If you would like us to respond by mail, please enter your address.
　If you wish to receive a response by email, we will contact you at the email address you have just entered

■ Email address: the same as above
■ Address / Addressee's name
*Please enter your zip code, address (branch number, building name, and room number), and addressee's name

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〇What would you like to whistleblow or consult?
(We will report what you entered directly to the company)

[Required] Whistleblowing / Consultation Category: Violation of laws and regulations/Violation of company rules/Harassment consultation/Opinions, requests, and suggestions for improvement

[Optional] Occurrence time:

[Optional] Occurrence place:

[Optional] Recognition time:

[Required] Details of whistleblowing / consultation:

[Required] Request to the company:

[Required] Recognition of the surroundings: Yes / No

[Required] Evidence: Yes / No

*If you have any evidence, please provide it as an attachment if you don't mind
*The evidence will be submitted to the company as it is. If you wish to remain anonymous, please make sure that your information is not included.
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〇Who did that?

[Optional] Company Name:

[Optional] Department:

[Optional] Job Title:

[Optional] Name:

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