Whistleblowing form Your relationship with the Organisation: * Category/Type of application: * Bribery / corruptionTheft / misappropriation of assetsFalsification of dataFraudulent Accounts/Financial FraudConflict of InterestMobbing / Discrimination / ExploitationSecurityOther (please describe)Other Related area of activity: * Department: * Data of the infringer: * Date of application: * Additional information: Please answer as many questions as possible to help us process your application.a) Parties involved: * b) Description of the case/situation: * c) Time frame: * d) Location of incident: * e) Estimated loss (its value; if any): *: f) Source of information: * g) Has the irregularity been previously reported to the Organization? * Attachments (if any) Feedback: To enable us to provide you with information regarding your application, please complete the following e-mail by indicating the channel/method of communication. Declaration of consent to processing of personal data in the process of reporting violations and irregularities in Bioton S.A. I agree to the processing of my personal data in the process of reporting violations and irregularities in Bioton S.A., in accordance with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27.04.2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data and repealing Directive 95/46/EC (General Data Protection Regulation) (OJ EU. L. 2016 No. 119, p. 1). I provide my personal data voluntarily. I have read and understood the contents of the "Information clause for whistleblowers at Bioton S.A.". Information clause for whistleblowers at Bioton S.A. Fulfilling the information obligation under the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27.04.2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (OJ EU. L. 2016, No. 119, p. 1) - hereinafter RODO, we inform you that: 1. the administrator of your personal data is Bioton S.A. with its registered office at 5 Starościńska Street, 02-516 Warsaw, address for correspondence: Macierzysz, Poznańska 12 Street, 05-850 Ożarów Mazowiecki. 2. The following email address is used to contact the Data Protection Officer of Bioton S.A: firstname.lastname@example.org. 3. Your personal data are processed for the following purposes: 1) to take actions related to determining whether the reported act or omission is an actual or potential violation of generally applicable laws, including the Law on Prevention of Money Laundering and Financing of Terrorism or procedures adopted by the Company to prevent money laundering and financing of terrorism, anti-corruption procedures, anti-bribery procedures; 2) perform actions against the report as part of the process of reporting violations. 4. The legal basis for processing by Bioton S.A. Your personal data for the purposes indicated in section 3 above is: 1) fulfilling legal obligations (in accordance with Art. 6(1)(c) RODO) incumbent on Bioton S.A. under legal regulations resulting from the Act on preventing money laundering and terrorist financing, the Regulation of the European Parliament and the Council (EU) on market abuse; 2) Legitimate interest of Bioton S.A. (in accordance with Article 6(1)(f) of the RODO). 5. Your personal data may be disclosed by Bioton S.A. to authorized entities, in particular to law enforcement agencies, if necessary in connection with the verification of the notification, in accordance with the procedure set by mandatory provisions of law. 6. Your personal data will be processed for the period necessary to achieve the purpose of processing, i.e. to clarify the irregularity covered by the notification. As soon as this purpose has been achieved, the personal data contained in the notification shall be deleted, while other information contained in the whistle-blowing notifications and the information on the follow-up action taken shall remain in the systems for a period of 5 years, starting from the first day of the year following the year in which the information was developed, maintained or drawn up. 7. Providing your personal data is voluntary. 8. You have rights in relation to the processing of personal data: 1) the right of access to the content of your data; 2) the right to rectify your personal data; 3) the right to erasure of personal data or restriction of processing; 4) the right to data portability, i.e. right to receive personal data from Bioton S.A, in a structured, commonly used and machine-readable IT format. You may send the data to another controller or request that Bioton S.A. sends the data to another controller. However, Bioton S.A. will only do this if such a transmission is technically possible. The right to data portability shall only apply to data processed under an agreement with you, - the right to object - in cases where Bioton S.A. processes your personal data on the basis of its legitimate interest; the objection can be expressed due to a particular situation to the following e-mail address: email@example.com or the address of the registered office of Bioton S.A. with the note "Data Protection Inspector". 9. You have the right to lodge a complaint to the President of the Office for Personal Data Protection. Additional information: Please answer as many questions as possible to help us process your application. The fields marked with an "*" must be completed in order to submit your application.