Self-reporting form

About you

First name

Last name

Role or job title

Phone

About your organisation

Organisation name

Alternative names the organisation may be known by

Organisation type

Registered charity with the Charity Commission for England and Wales or Northern IrelandRegistered companyCommunity Interest Company (CIC)Please tick all that apply

Registered charity no.

Registered company no.

CIC registration no.

Have you informed the trustees about the incident you are reporting?

If reporting as a trustee, please select yes

Organisation address, Head Office

Address line 1

Address line 2

Town or City

Nation

Postcode

Organisation address, Local Office/branch (if relevant)

Address line 1

Address line 2

Town or City

Nation

Postcode

Your report

If there was a specific date of any 'incident' please indicate below

When did you find out about the incident?

If there was not a specific date please give an indication e.g. last week a complaint was made on our website.

Detail of incident

Please provide as much information about the incident as possible, for example what has happened or could happen and the names of any affected campaigns, websites or organised events.

Your reponse

Have you taken any action to resolve the incident?

Please give more information about what action you have taken so far to resolve the incident.

What action (if any) will you be taking to prevent this happening again?

Has anyone reported to or complained directly to your organisation about the incident?

Please tell us who (for example, a member of staff raised the issue, a member of the public reported it us)

Have the people affected by the incident been contacted?

Please tell us about the information you gave to them:

Have you reported the incident to any other regulators/relevant bodies?

Please specify which regulators/relevant bodies

Is there anything specific that you would like the Fundraising Regulator to help or support you with?

Please upload any relevant supporting information. For example, your action plan, copy of report to other regulators, copy of complaint response. You can upload up to five documents, we will hold these securely in line with our privacy policy. If we need more information we will get in touch with you.