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Whistleblowing Form

Whistleblowing Form 

 

 

 

Important Notice

 

While all reporting of improper conduct in good faith and not for malicious intent will be investigated, a Whistleblower is encouraged to identify himself/herself when reporting, for credibility purposes and to allow an avenue for us to follow up to ascertain the facts or to obtain further information for investigation purposes. 

 

Please attach reliable evidence to substantiate your disclosure and assist in the investigation. You may use additional sheets for additional witnesses or supporting evidence, if necessary.

 

Part A : Disclosure Details

Name of person(s) involved in the incident or issue:

* Please provide name of person(s) involved in the incident or issue.

  Department/Designation: 

* Please provide department of designation.

  If money is involved, please indicate the amount involved: 

* Please provide the amount of money involved.

 

* Please provide the detail of the person that you suspect is involved.

  Do you suspect that the management is involved? Please provide the details if any. 

* Please provide the detail of management that you suspect is involved.

  Have you notified anyone? Please provide the details, if any. 

* Please provide the details of your notify.

  Any witness? Please provide the name, department, and other relevant details. 

* Please provide the name, department, and other relevant details.

  Date, Time, and Location of the incident or issue? 

* Please provide date, time, and location of the incident or issue.

 How did you discover the incident or issue? 

* Please provide how you discover the incident or issue.

 Please provide a description of the incident or issue.  

* Please provide a description of the incident or issue.

 

Part B  : Whistleblower Details

Are you an employee of the Company?: 

* Please provide your answer.

  Name: 

* Please provide your name.

 Contact Number or Email Address (Mandatory):

* Please provide your contact number or email address.