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What is the nature of your tip? *

Statement issues

Non payment by employer

Short title of issue *Write a brief of your issue

Full description of issue *Describe your issue in detail

Name of the defaulting company *Type the name of the defaulting company here

Number of employees at the defaulting company *Specify the number of employees of the defaulting company

Physical Address *Add a physical address of the location of the defaulting company or where the incident happened

Director's Name/Number *Add a name or a mobile number of the director

Other relevant information *Add any other information to enable NSSF team investigate this matter to a logical conclusion

Estimator

Do you want to remain anonymous?

Yes

No

Names

Gender

Female

Male

Are you registered with NSSF?

Yes

No

If yes, input your NSSF Number

When did you start working?

When did you stop working?

Frequency of payment

Weekly

Monthly

Other

How are you paid?

Cash

Bank

Other

Year	Gross Salary Average monthly gross salary during this period	Contribution Total contributions during this period	Remitted Average monthly remittance during this period	Arrears Total arrears during this period	Interest Total interest during this period	Closing Balance Closing balance during this period

Files description In case of any file to be attached, describe it here (ensure your files cannot identify you).

Files Image/Document/Video/Audio [To ensure files from your laptop or phone cannot be traced to you, remove file properties or metadata prior to uploading.]

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To further enhance your security, please follow these instructions:

In the event that you would like to remain anonymous, do not submit any personal information. (e.g. your name or relationship to the offender. Do not submit any information that can be traced back to you.)
Please do not submit your report on a PC provided by your employer. Particularly an intranet connection may jeopardize your anonymity.

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