Reporting Form for non-compliance

Nomura Group established reporting form for non-compliance with Supplier CSR Guideline. Through this form, we expect to receive reports and respond fairly and transparently with a view to resolving reported cases promptly.
Please fill out the reporting form below and select the “Confirm” button.

1 Enter Information

2 Confirm

3 Finished

NameRequired field

(example) Taro Yamada

First Name

Last Name

Address

(example) Otemachi

CityRequired field

(example) Chiyoda-ku

StateRequired field

(example) Tokyo

Zip CodeRequired field

(example) 1000004

TelephoneRequired field

(example) 03-5255-1000

E-mail AddressRequired field

(example) aaa@aaa.co.jp

Retype your E-mail address

I would prefer to remain anonymousRequired field

Yes No

Name of company you want to reportRequired field

(example) Nomura Holdings

Address of company you want to report

(example) Otemachi

City of company you want to reportRequired field

(example) Chiyoda-ku

State of company you want to reportRequired field

(example) Tokyo

Zip Code of company you want to reportRequired field

(example) 1000004

Information regarding products procured by Nomura GroupRequired field

Product name (example) Photocopy paper

Relationship between you and the company you are reportingRequired field

(example) Employer and employee

Details of non-compliance with GuidelineRequired field

(plain text only, 1,000 character limit)

Provision of Guideline subject to non-complianceRequired field

(plain text only, 1,000 character limit)

Action you expect us to takeRequired field

(plain text only, 1,000 character limit)

Record of dialogue with company being reportedRequired field

(plain text only, 1,000 character limit)

Is this non-compliance pending conflict resolution procedure?Required field

Yes No

Agent (if applicable)Required field

Yes No

Name of agent

(example) Taro Yamada

First Name

Last Name

Address of agent

(example) Otemachi

City of agent

(example) Chiyoda-ku

State of agent

(example) Tokyo

Zip Code of agent

(example) 1000004

Telephone number of agent

(example) 03-5255-1000

E-mail address of agent

(example) aaa@aaa.co.jp

Retype E-mail address of agent

Confirm