Whistleblower

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Please provide the following details for any suspected serious misconduct or any breach or suspected breach of law or regulation that may adversely impact the Company. Please note that you may be called upon to assistin the investigation, if required.

Note: Please follow the guidelines as laid out in the Whistleblowing Policy

REPORTER’S CONTACT INFORMATION

(This section maybe left blank if the reporter wish to remain anonymous)

Name

Name

Designation

Designation

Department

Department

Contact

Number

Email Address

SUSPECT’S INFORMATION

Name

Name

Designation

Designation

Department

Department

Contact

Number

Email Address

WITNESSES’S INFORMATION (if any)

Name

Name

Designation

Designation

Department / Agency

Department / Agency

Contact

Number

Email Address

COMPLAINT: Briefly describe the misconduct /improper activity and how you know about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.

1. What misconduct / improper activity occurred?more details
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2. Who committed the misconduct / improper activity?more details
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3. When did it happen and when did you notice it?more details
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4. Where did it happen?more details
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5. Is there any evidence that you could provide us?more details
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6. Are there any other parties involved other than the suspect stated above?more details
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7. Do you have any other details or information which would assist us in the investigation?more details
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8. Any other comments?more details
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