Add a European (EU) Whistleblower verification form

Question:
[I am required to add a return form as attached to meet EU Whistleblower standards.]

Product:
[Wix Studio Editor.]

What are you trying to achieve:
[ ANONYMOUS REPORTING FORM

Eurofoil undertakes to implement, within the limits of applicable legislation, all necessary procedures to ensure the anonymity of information received concerning the identity of the whistleblower as well as that relating to the identity of third parties cited in the report received.]

What have you already tried:
[Share resources, forum topics, articles, or tutorials you’ve already used to try and answer your question.]

Additional information:
[Attached is from their old web site and the code. So I need to implement something similar in their new Wix Studio site. www.eurofoil.com. Any help would be appreciated! I do have the old code available.]