KPMG Ethics Line

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IMPORTANT - PLEASE READ BEFORE COMPLETING THIS FORM

The Company has appointed KPMG as its third party service provider to facilitate the handling of matters of serious concern in relation to the Company’s Speak Up Policy. Please provide detailed information to enable the Company to conduct a thorough investigation in relation to your matter of serious concern.

The Company will protect and support anyone raising genuine matters of concern. KPMG will not disclose your identity to the Company if you select the option not to share this information with the Company in Section 1.4 below. However, if you do not tell the Company who you are, it will be much more difficult for the Company to look into the matter or to protect your position or to give you feedback. If you ask the Company to protect your identity by keeping your identity confidential, the Company will not disclose it without your consent. In serious circumstances when the information results in legal or criminal proceedings the authorities may require disclosure of your identity and the Company will comply accordingly.

Please specify:

1.2 Where is the company located?

Department / Section:
Address:
City:
Province:
Country:

1.3 Please indicate your relationship to the company reported.

Customer
Team member
Ex-team member
Supplier/Vendor
Other

Please specify:

1.4 Would you like to provide contact information for further follow-up? (Name is optional)

I would like to provide contact information to both the Company and KPMG.
I would like to provide contact information to KPMG only.
I do not want to be contacted.

Name:
Contact information:

Name:
Contact information:

2.1 Please select the applicable Incident Type from the list below that best describes the issue(s) you are reporting:

Corruption (including: Bribery, Favouritism)
Cyber security (including: Data breach, Malware attack)
Fraud (including: Falsification of documents, Financial irregularities, Misuse of company assets)
Management issue (including: Abusive behaviour (coercion, discrimination, harassment, etc.), Unfair dismissal, Unreasonable superior, Unsafe working environment)
Regulatory compliance (including: Labour-related, Lack of licenses)
Serious injuries / fatalities
Theft
Other

Please specify:

3.1 Do you know the name of the person(s) or organisation(s) involved?

Yes
No

Name(s):

3.2 Do you want to add another involved party?

Yes
No

If yes, please provide name?

3.3 Has management been notified?

Yes
No

Please provide the name of the person/s notified.

First name
Last name
Title
What date was the individual notified?	YYYY-MM-DD

4.1 When did the incident occur?

YYYY-MM-DD

4.2 Where did this incident occur?

4.3 How do you know about this incident?

4.4 Is any supporting information available?

Yes
No

E-mail address:
Please provide your e-mail address so that KPMG can contact you and arrange for the transfer of the supporting information you possess in order to support your matter of serious concern.

4.5 Please provide a detailed description of the incident. Provide as much detail as you are able to, using times, dates, places and names whenever possible. Indicate WHO did it? WHAT did the person do? WHERE did the person do it? WHEN did the person do it? HOW did the person do it? Please note that this field is limited to 5,000 characters.

4.6 Do you know whether this incident will reoccur:

Yes, it will occur again in the next 24 hours
Yes, but after 24 hours
No, it will not occur again, or I don't know

By ticking this box, I agree to the Processing of my Personal Information, as defined in the Protection of Personal Information Act, No. 4 of 2013, by KPMG and its sub-processors, for purposes of KPMG providing hotline services with DFI Retail Group and as it relates specifically to this submission. I confirm that with this consent, KPMG and its sub-processors will be permitted to Process my Personal Data for any purpose relating to the services as stipulated above.