Microsoft Word - Auria Hourly Handbook November 2021 - FINA

Auria Solutions USA Inc. ("Auria") Code of Business Conduct and Ethics Complaint Reporting Form

INFORMATION REGARDING REPORTING PERSON

Name :

Phone :

Address :

Date :

(mm-dd-yyy)

Email : Check to the right from where is the contact information above (check one) : Select below the Reporting Person's relationship with Auria and to the right the Name : Employee Contractor Other Geographic Location of Reporting Person : Relationship of Reporting Person to those who are believed to have committed some misconduct :

Home

Work

Customer

Supplier

COMPLAINT INFORMATION

Date(s) of Incident :

Time of Incident :

(mm-dd-yyy)

Auria Department involved :

Geographic Location of incident :

Auria Entity invoved (e.g. department, plant, etc) : Select below if you believe there was a Violation of Law, Unethical Behavior or Violation of Company's Policy? (e.g. fraud, missappropriation of company assets, etc). Violation of Law : Violation of Company Policy : Unethical Behavior : Estimated monetary amount of loss : Do you have any documents related to the alleged misconduct? Yes No Description of the incident (provide detiled narrative of who, what, where, when, why and how; attach additional pages if necessary:

Select below the Alleged Wrongdoer's relationship to Auria - to the right the Name or Department : Employee Contractor Other

Customer

Supplier

Does the alleged wrongdoer works in Finance, Accounting, Audit Services, Legal or Purchasing?

Yes

No

Provide the Job Title of the Alleged Wrongdoer : Describe the nature of this person's involvement in the alleged misconduct:

INTAKE INFORMATION (to be completed by recipient)

Date of receipt :

Person receiving :

Phone :

(mm-dd-yyy)

WHERE TO SEND THIS COMPLETED FORM

Complete and submit this form to: * Auria's Corporate HR Department at smbx-ww13@auriasolutions.com * Or call Corporate HR at 1-864-612-4809 If this matter is a traditional employment matter, send one copy of this Form to your Local Human Resource Representative, if appropriate.

51