Client 1 Tipline Merged -

Test page for Merged tipline

Tipline Client 1 with organisation login

1Terms of Service

2Privacy

3Contact Information

4What Happened

5Location

6Dates

7People Involved

8Additional Information

9Review & Submit

Organization Code

Enter the code provided by your organization

1. Agree to the Terms…

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I agree to the Terms of Service

You must scroll to the bottom of the form and agree to the terms to proceed.

2. Select Your Privacy Setting

Privacy Options(Required)

I want to remain anonymous.

My identity will be known to ClariumFCS but not Client 1

My identity will be known to Clarium FCS and Client1

1. If you ask to remain anonymous, you will not be required to enter your name, email address, or phone number.
2 & 3 You will be required to enter your email address. You can choose whether to enter your phone number.

3. Provide Your Contact Information

Name(Required)

First Last

Email(Required)

Phone

Contact Preference(Required)

Phone

You chose to remain anonymous at Step 2.
You do not need to enter your contact information. We will not be able to follow up with you regarding your submission.

4. Describe What Happened

Briefly describe the problem(Required)

You can provide more details later if you would like.

5. Tell Us About Where the Problem Happened

Where did the problem occur?(Required)

Describe where the problem occurred.

Provide an address where the problem occurred

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the address if known.

6. Tell Us About When the Problem Happened

Describe when the problem happened(Required)

You can include information about what was happening at the time (e.g. the type of activity, what you and/or other people were doing at the time).

How often has the problem occurred?

Once

More than once but is no longer happening

Ongoing

You will have the option to provide dates next.

Date

DD dash MM dash YYYY

If possible, tell us when the problem occured.

Start Date

MM slash DD slash YYYY

If possible, tell us when the problem began.

End Date

MM slash DD slash YYYY

If possible, tell us when the problem ended.

Date

MM slash DD slash YYYY

If possible, tell us when the problem began.

7. Tell Us Who Was Involved

Explain who was involved and their roles in the problem.(Required)

You have the option to provide details below.

Add details about someone's involvement(Required)

Yes

To add details, you should know the name of the person.

Name(Required)

First Last

If possible, provide the person’s name

Title or Position

Leave blank if unknown

Role During Problem

Add a Second Person(Required)

Yes

Name(Required)

First Last

Title or Positiom

Role During Problem(Required)

Were there any witnesses when the problem happend?(Required)

Yes

Rather not say

Who were the witnesses and what role did each witness play?(Required)

If known, you can provide the names of the witnesses and their role when the problem occurred..

8. Provide Additional Information

Have you reported this problem before?(Required)

Yes

Date

MM slash DD slash YYYY

Provide the date when you first reported the issue.

Describe your experience when you reported this problem

If you recall, include the date, how you reported it and who you reported to.

Do you want to upload any supporting documentation?(Required)

Yes

File(Required)

Drop files here or

Accepted file types: pdf, jpg, png, doc, docx, csv, xls, xlsx, Max. file size: 128 MB, Max. files: 6.

You can upload PDFs, images (jpg), documents, or spreadsheets (csv, xls, xlsx). A total of 6 uploads is allowed.

Provide any additional information you think is important

9. Review and Submit

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Unique ID

This field is for validation purposes and should be left unchanged.

Client 1 Tipline Merged

Tipline Client 1 with organisation login

1. Agree to the Terms…

2. Select Your Privacy Setting

3. Provide Your Contact Information

4. Describe What Happened

5. Tell Us About Where the Problem Happened

6. Tell Us About When the Problem Happened

7. Tell Us Who Was Involved

8. Provide Additional Information

9. Review and Submit

Clarium Fraud & Compliance Solutions

Edmonton, Alberta, CA

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