Anti-Corruption Trust of Southern Africa (ACT-Southern Africa)
-Campaigners against Corruption in Southern Africa-
REPORTING FORM
Note: The Anti-Corruption Trust of Southern Africa (ACT-Southern Africa) has a dedicated team of
lawyers who advises individuals and institutions on corruption related cases and where possible refer to
appropriate agencies for further assistance.
ALL INFORMATION WILL BE TREATED WITH STRICT CONFIDENTIALITY
1. Personal Details
Title
Full Name
Country
Mr.
Ms.
Dr.
Mrs
Miss
Mark your country of residence
Angola
Botswana
DRC
Lesotho
Madagascar
Malawi
Mauritius
Mozambique
Namibia
Seychelles
South
Africa
Swaziland
Tanzania
Zambia
Zimbabwe
Physical
Address
Postal Address
Contact
Numbers
E-Mail
Work
Cell
Home
2. Your Complaint
2.1 Who are you complaining against?
Title
Full Name
Mr.
Ms.
Dr.
Mrs
Miss
Position
Mark the country where the case happened
Page | 1
Country
Angola
Botswana
DRC
Lesotho
Madagascar
Malawi
Mauritius
Mozambique
Namibia
Seychelles
South
Africa
Swaziland
Tanzania
Zambia
Zimbabwe
Organisation
Physical
Address
Postal Address
Contact
Numbers
E-Mail
Work
Cell
Home
2.2 Why are you making a report to ACT-Southern Africa?
The case falls under which of the following category. We have made an effort to define what
each category entails but this is largely determined by national legislation in each of the SADC
member states.
Type of Case
Bribery1
4
Extortion
6
Nepotism
Trading in influence
Concealment
Mark
Type of Case
Embezzlement2
Mark
5
Abuse of Discretion
Improper political
7
contributions
Illicit enrichment
Obstruction of justice
Type of Case
Fraud3
Mark
Conflict of Interest
Abuse of office or functions
Laundering of proceeds of crime
1
Bribery is a broad term that entails the offering of money, services, company shares, inside information, sexual and other favours,
entertainment, employment or other valuables to persuade someone to do something in return. Synonyms: kickbacks, baksheesh, payola, hush
money, sweetener, protection money, boodle, and gratuity. The benefit may be passed directly or indirectly to the person being bribed, or to a
third party such as a friend, relative, associate, favourite charity, private business, political party or election campaign. Types of bribery include:
influence peddling, offering or receiving improper gifts, bribery to avoid liability for taxes or other costs, bribery in support of fraud, bribery to
avoid criminal liability, bribery in favour of unfair competition and bribery to obtain confidential or inside information to name but a few.
2
Embezzlement: the taking of money, property or other valuables by the person to whom it has been entrusted for personal benefit.
3
Fraud: the use of deceit, trickery or false pretences to induce someone to turn over money, property, or other valuables voluntarily.
Synonyms: swindle, deceit, double-dealing, cheat, and bluff
4
Extortion: the demanding or taking of money, property or other valuables through use of coercion and/or force. A typical example of extortion
would be when armed police or military men exact money for passage through a roadblock. Synonyms include blackmail, bloodsucking and
extraction.
5
Abuse of discretion: the abuse of office for private gain, but without external inducement or extortion. Patterns of such abuses are usually
associated with bureaucracies in which broad individual discretion is created, few oversights or accountability structures are present, as well as
those in which decision-making rules are so complex as to neutralise the effectiveness of such structures even if they exist.
6
Nepotism: a form of favouritism that involves family relationships. It decribes situations in which a person exploits his or her power and
authority to procure jobs or other favours for relatives.
7
Improper political contributions: payments made in an attempt to unduly influence present or future activities by a party or its members when
they are in office.
Page | 2
Or I have other information apart from the above that I wish to share
2.3 When did this happen?
Date
Time
Place
2.4 What happened?
Describe in detail the events that you want to make a report about. We need to know what happened,
where it happened, when it happened and how it happened? Please give us details about dates,
locations and other specific details as you can remember regarding the alleged act of corruption.
Page | 3
2.5 Who else witnessed the incident?
Ref
Name
Address
Tel
e-mail
2.6 Are you making this report on behalf of someone else?
Yes
No
If YES, when, where and how did you become aware of this incident?
If NO, are you a witness to this allegation?
Page | 4
3. Further Information
3.1 Supporting evidence
Please attach copies of any documents that may help us investigate your complaint, such as pictures, emails, letters, receipts, and other records. If you cannot do this, please tell us about the documents or
other evidence and how this evidence can be obtained
3.2 What outcome are you seeking?
Page | 5
3.3 Are you willing to meet with members of the ACT-Southern Africa, should more information
be required?
Yes
No
3.4 Have you made a complaint or discussed this alleged act of corruption with another person
or agency?
If so please provide details of the person/agency you have discussed with and give details of
outcomes of such interaction. Please also attach copies of any letters you have received from
the person/agency
3.5 Have you tried to resolve the matter in any other way?
If so give details:
Page | 6
3.6 Give any other information that you want to share with ACT-Southern Africa
DECLARATION
I hereby swear or affirm that the above information and relevant supporting documentation is to the
best of knowledge and belief accurate and is provided in good faith.
____________________________________________
______________________________
Signature
Date
Remember to:
•
•
Sign and date this document; and
Attach relevant copies of any documentation
Send to :
Anti-Corruption Trust of Southern Africa
Legal Services Programme
46 Lawson Avenue, Milton Park,
P. O. Box A1782, Avondale,
Harare, Zimbabwe
Telephone: +263773302830
e-mail:
actlegalprogramme@gmail.com
actsouthernafrica@gmail.com
For Official Use Only
Case Reference Number
Date and Time Received
Name of a Legal Representative assigned
Complaint Accepted/Rejected
Page | 7