Whistleblower Name (Nama Pengadu)

Whistleblower Designation (Jawatan Pengadu)

Whistleblower Staff ID (ID Pekerja Pengadu)

Whistleblower Department/Division (Jabatan Pengadu) Whistleblower Department/Division (Jabatan Pengadu)Human Resources and AdminITProductionProjectMarketingIPADFinanceSafetySalesLegal and Public RelationsProcurementQA/QCOthersNot applicable (Tidak berkaitan)

Whistleblower Contact No. (No. Telefon Pengadu)

Whistleblower E-mail (Emel Pengadu)

Suspect Name (Nama Suspek)

Suspect Company (Syarikat Suspek)

Suspect Contact No. (No. Telefon Suspek)

Suspect Email (Emel Suspek)

Witness Name (If any) (Nama Saksi (Jika ada))

Witness Company (If any) (Syarikat Saksi (Jika ada))

Witness Contact No. (If any) (No. Telefon Saksi (Jika ada))

Witness Email (If any) (Emel Saksi (Jika ada))

What is the nature of your report? (Apakah jenis laporan anda?) What is the nature of your report? (Apakah jenis laporan anda?) Fraud (Penipuan) Bribery (Rasuah) False Claim (Tuntutan Palsu) Abuse of Power (Penyalahgunaan Kuasa) Harrasment (Gangguan) Conflict of Interest (Konflik Kepentingan) Theft for Embezzlement (Pencurian untuk Pengelapan Kewangan) Misuse of Company's Properties (Penyalahgunaan Harta Syarikat) Others (Please Specify) (Lain-lain (Sila Nyatakan))

If Others Nature (Jika lain-lain Laporan)

Briefly describe the issues below: (Huraikan isu secara ringkas di bawah:)

Who committed the misconduct/improper activity? Are there any other parties involved other than the suspect mentioned above? (Siapakah yang melakukan aktiviti salah laku/tidak wajar? Adakah pihak lain terlibat selain suspek yang disebutkan di atas?

When did this incident or issue occur? (Bilakah kejadian atau isu ini berlaku?)

Is there any evidence that you could provide? (Supporting document attached) (Adakah terdapat bukti yang dapat anda berikan? (Lampirkan dokumen sokongan)) Is there any evidence that you could provide? (Supporting document attached) (Adakah terdapat bukti yang dapat anda berikan? (Lampirkan dokumen sokongan)) Yes (Ya) No (Tiada)

Upload Evidence Choose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, png, wax. Max. file size: 20 MB

Do you have any other details or information which would assist us in the investigation? (Adakah anda mempunyai maklumat lain yang dapat membantu siasatan?)