* Mandatory field.

1. Whistleblower’s identification details

* Mandatory field.

2. Description of the facts

*Please explain your concern in the box below. Please, do your best to offer as much detail as you can about the following:

· Details of the facts and/or signs of which you are aware in relation to the alleged non-compliance and when you became aware of it.

· Indicate the business area, company and region in which the alleged non- compliance occurred.

· Data identifying the reported party/ies (names and surnames). If you are a CLG’s professional, please indicate the company, the department in which you belong to and the position you occupy. If not, please indicate the company to which you belong and the relationship you have with CLG.

· Indicate, how and where the alleged non-compliance occurred, if you are aware of it.

· Indicate whether, apart from the reported party, you believe that there are more persons within GLG or third parties outside the Group who may be involved in such breach, or have knowledge or could reasonably have knowledge of such breach:

*Have you previously reported the facts? Mark it with a cross.

* Mandatory field.

3. Evidences

If so, indicate and provide:

· The evidences that you have to support the report.
· The evidences held by CLG that can support the denounced facts.