Whistleblowing Disclosure- Governance Professional

Please note that this form can be used to make a disclosure regarding the Governance Professional only. If you wish to make a disclosure about anyone other than the Governance Professional please click here to be taken to the relevant form.

Whistleblowing Disclosure Form – Governance Professional

Part 1 involved parties

Name & job title

Insert the name and job title of the person/people that you are reporting. Write ‘not known’ if you do not have this information.

Contact details

Provide a contact telephone number/email address/postal address of the involved parties. Write ‘not known’ if you do not have this information

Involvement

Explain the involvement of each person you are reporting in the activity that you are concerned about

Firm name

If a firm or organisation is involved, please provide their name. Write N/A if this is not relevant

Contact details

Provide a contact telephone number/ email address/ postal address for each named firm. Write ‘not known’ of you do not have this information. Write N/A if this is not relevant

Involvement

Provide as much accurate, factual detail as you can about the named firm(s) involvement in the activity you are concerned about

Public interest disclosure

Remember to include as much factual information as possible. Factors to consider include: – Date(s) of activity – The name or names of people involved, along with the nature of their involvement – The precise details of the activities which you are concerned about – The precise location(s) where the reported activities took place

Your concern

Have you raised this concern with anyone else?

If ‘yes’, provide details of when and who you reported the concern and what their response was.

Evidence

List the evidence you are providing. This may include correspondence, photographs or video evidence. For each item, provide an explanation of what the evidence is, how it was obtained and how it relates to your disclosure. You can use the file upload function below to do this

File

Max. file size: 64 MB.

Personal details

Your personal details will only be known to the staff directly involved in the management of your whistleblowing disclosure. If you submit an anonymous disclosure, HNC will be unable to contact you with additional questions and this may restrict our ability to take meaningful action in response to your disclosure. Therefore, if you are not providing your contact details, please ensure you have provided as much information as possible, including specific details where this is known.

Name (if supplied)

How we can contact you (if supplied)

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