IRMA Stakeholder Feedback Form

Name*

Location

Email *

Telephone

Name of the mine you are providing feedback for

*RELATIONSHIP WITH THE MINE: Community member including any resettled/relocated groups Education or academia Indigenous or traditional authority representative Media Mine employee Mine contractor or supplier Non-governmental organisation (NGO) Labour union Local group, including social/community development, business, and industry sector groups Service provider, including healthcare, police, security and emergency services

Other interested party - Please provide details:

PLEASE TELL US ABOUT YOUR EXPERIENCE WITH THE MINE, INCLUDING ANYTHING RELATED TO WHAT INFORMATION YOU RECEIVE FROM THE MINE, AND THE IMPACT OF THE MINING OPERATION ON THE LOCAL COMMUNITY, HEALTH & SAFETY OF WORKERS, AND THE ENVIRONMENT:

Would you like to participate in an interview with the ERM CVS audit team during our next on-site assessment?

PREFERRED METHOD OF INTERVIEW: Virtual Interview In-person interview

*CAN THE FEEDBACK YOU PROVIDED BE SHARED PUBLICLY AS PART OF THE MINE AUDIT REPORT?

Field marked with (*) are mandatory.

Consent: * I would like ERM CVS to keep me updated on future news and understand that the information provided by me is subjected to ERM's privacy statement.