* Indicates required information. This form is divided into three sections: Section One: Information about the reported person/company. Section Two: Use of information. Section Three: Reporter’s information. We understand that some requested information is not available, please enter all information available to you as it will be helpful in the reporting process. To protect your confidentiality and goodwill, please consider the following: 1- Fill in and submit the reporting form with integrity and confidentiality. 2- Refrain from any law-violating actions in pursuit of obtaining more information. Name of person/company* Company’s address Phone number Company’s sector Company’s establishment date Profit and loss distribution shares Date of Reported tax evasion Tax evasion details * Section Two: Use of information. To help us evaluate the appropriate use of provided information, please complete the following: Your connection to the reported person or company Are you still in touch with the reported person/company? YesNo Check if more individuals are aware of the reported tax evasion. YesNo Please state the number of individuals Check if reporting this tax evasion would impact you. YesNo Please state how this reporting would impact you: Check if reporting this tax evasion would impact others. YesNo Are you willing to come in person to General Tax Authority and repeat this information? YesNo Other information that you think is relevant * Section Three: Informer’s information. Please complete the details below in case we need to contact you to clarify additional information. General Tax Authority makes sure to keep your information secure and confidential. Surname First name Career information Mobile number * Convenient time to contact you at Thank you for your cooperation. We would like to inform you that the General Tax Authority will do the necessary to verify the information provided.
