Report form - PCF Procefar Sp. z o.o.

1. GENERAL INFORMATION

Legal basis • Directive (EU) 2019/1937 of the European Parliament and of the Council of 23 October 2019 on the protection of persons who report breaches of Union law (EU Directive)
• Act of 14 June 2024 on the protection of whistleblowers

Date of completion of the form

Reporting Entity Enter the first and last name or the company name to which the Report relates

Subject of the report In accordance with Article 3(1) of the Act of 14 June 2024 on the protection of whistleblowers

2. CONTACT DETAILS OF THE REPORTING PERSON

Type of Report Anonymous report
Submitting an anonymous report makes it impossible to contact the Reporting Person, which means that the Reporting Person will not receive feedback regarding the report.

Identified report
Submitting an identified report enables contact with the Reporting Person, which means that the Reporting Person will receive feedback regarding the report. The reporter’s data will not be made public.

identifiedanonymous

First and last name Phone number Email Correspondence address

3. INFORMATION ABOUT THE REPORTED BREACH OF LAW

Date of occurrence of the event subject to the Report Date on which information about the event subject to the Report was obtained Place of occurrence of the event subject to the Report Enter the exact location of the Event – address, room, name of the Organizational Unit

POTENTIAL WITNESSES Enter the first and last names of potential witnesses to the event; if there were none, enter “No witnesses”
First and last name Description of the Report Detailed description of the Report, including persons involved in the event as well as the place and circumstances of the Report

4. EVIDENCE RELATED TO THE REPORT

Enter the name and type of evidence confirming the breach. Describe the circumstances under which the evidence was obtained and attach supporting documentation, e.g. photos, videos, audio files, emails, screenshots, notes, SMS messages or other documents.

Do you have evidence related to the report? yesno

Name/type of evidence Description of circumstances confirmed by the evidence Indicate information about the attached evidence / what the evidence concerns, date of obtaining the evidence, etc. Name/type of evidence Description of circumstances confirmed by the evidence

5. ATTACHMENTS RELATED TO THE REPORT

Attach photos, documents, video recordingsAttachment 1 – name Attachment 2 – name

6. INSTRUCTIONS

LIABILITY Pursuant to Article 57 of the Act of 14 June 2024 on the protection of whistleblowers (Journal of Laws 2024, item 928, as amended), anyone who submits a Report or makes a Public Disclosure knowing that no breach of law has occurred shall be subject to a fine, restriction of liberty or imprisonment for up to 2 years.
Other criminal provisions concerning reporting and disclosure of identity are regulated in Articles 54–59 in Chapter 6 “Criminal provisions” of the Act of 14 June 2024 on the protection of whistleblowers.
Other provisions concerning liability are regulated in Articles 16–17 in the chapter “Prohibition of retaliatory actions and protective measures” of the Act of 14 June 2024 on the protection of whistleblowers, which indicate the basis and exclusions of liability. COMPENSATION Pursuant to Article 15 of the Act of 14 June 2024 on the protection of whistleblowers, a person who has suffered damage as a result of a deliberate Report or Public Disclosure of false information by a Whistleblower has the right to compensation or redress for violation of personal rights from the Whistleblower who made such a Report or Public Disclosure.
Pursuant to Article 14 of the Act of 14 June 2024 on the protection of whistleblowers, a Whistleblower who has been subjected to retaliatory actions is entitled to compensation in an amount not lower than the average monthly salary in the national economy in the previous year, announced for pension purposes in the Official Journal of the Republic of Poland “Monitor Polski” by the President of the Central Statistical Office, or the right to redress.

7. DECLARATIONS OF THE REPORTING PERSON

LIABILITY FOR PROVIDING FALSE INFORMATION I declare that I submit the Report voluntarily and I am aware of liability for making false statements.GOOD FAITH I declare that I submit the Report of a Breach of Law, being an act or omission contrary to the law or aimed at circumventing the law, in good faith.

PROCESSING OF PERSONAL DATA

Information clause for the Reporting Person Pursuant to Article 13(1) and (2) of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 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 (hereinafter: “General Data Protection Regulation”; “GDPR”), we inform that: PRODUCENCKA CENTRALA FARMACEUTYCZNA PROCEFAR SP. Z O.O., with its registered office in Wrocław, ul. Żmigrodzka 242 F, registered in the District Court for Wrocław-Fabryczna, 6th Commercial Division of the National Court Register under KRS number 0000141247, share capital PLN 110,000.00 – fully paid, NIP 895-17-82-288, REGON 932850524, BDO 000117917, is the Personal Data Controller (hereinafter: the Controller). In all matters related to the protection of personal data, contact may be made via email at: iod@hasco-lek.pl. The personal data of the Reporting Person are processed for purposes related to conducting explanatory proceedings in connection with reported breaches of law. The legal basis for the processing of personal data by the Controller is: a) compliance with legal obligations pursuant to Article 6(1)(c) GDPR, b) the legitimate interest of the Controller pursuant to Article 6(1)(f) GDPR, consisting in defense against claims and pursuing rights, c) establishment, exercise and defense of claims pursuant to Article 9(2)(f) GDPR. Personal data may be disclosed to authorized entities if necessary in connection with the verification of an Internal Report, in accordance with mandatory legal provisions. Personal data and other information in the Internal Reports Register are stored for 3 years after the end of the calendar year in which follow-up actions were completed or proceedings initiated by those actions were concluded. Providing personal data is voluntary but necessary to receive feedback on actions taken by the Controller. The Reporting Person has the following rights: access to data, rectification, erasure or restriction of processing, data portability, objection (which may be submitted due to a particular situation to iod@hasco-lek.pl or to the Controller’s address). The Reporting Person has the right to lodge a complaint with the President of the Personal Data Protection Office. Personal data will not be transferred to a third country or an international organization.