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INCIDENT REPORT
PRIVACY AND SECURITY
Vacaciones Diseñadas Terranova S.A

Please provide us with the followig information:

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* 1. Incident date, if you can't recall the exact date, please insert only the month.

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* 2. Employee name or department name

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* 3. Please be specific about the security or privacy issue you want to report

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* 4. Please provide us with your contact information