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People Involved (Names, Practice name)

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FraudCorruption/BriberyHarassment/DiscriminationWorkplace Safety ViolationConflict of InterestMisuse of Company ResourcesOther (Please specify)

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Detailed Description of the Incident

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Witnesses (If Any) - Name(s) and Contact Information

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Declaration & Consent

I declare that the information provided is accurate to the best of my knowledge. I understand that my identity (if provided) will be kept confidential to the fullest extent possible, in accordance with POPIA Laws.