WHISTLEBLOWING E-FORM

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Please provide the following details if you wish to report Improper Conduct which are unlawful and are in breach of law and regulations that may adversely impact the Group. Please be assured that your report will be treated as confidential.

Note: Please provide information as accurate as possible. The fields marked with (*) are required.

REPORT DETAILS

Name of Alleged Person *
Designation of Alleged Person *
Department of Alleged Person *
Company of Alleged Person *
Incident Date & Time
Location of Incident *

REPORT

Parties Involved (if any)
Types of Allegation *
Commission of fraud, bribery and/or corruption
Non-compliance with company's policies and breach of the company's Code of Ethics and Conducts
Negligence
Disclosure of company's confidential information including products and/or services without authorization
Mismanagement and/or abuse of authority
An act that endanger the lives, safety and health of company's assets and employees or the public or the environment
Unauthorized or misuse of company's fund, and/or facilities
Commissions of an act with the intention to hurt, intimidate, harass and/or victimize any employees of the Group.
Financial irregularity
Conflict of Interest
Description of Complaint *

1. Please describe the nature of your complaint. Include the details of the parties involved, date(s), time(s), location(s), etc. and any other relevant details.

Name of witness (if any)

2. Please provide details of witness(es) who can support your complaint e.g name, position, company etc.

Attachments

3. Please state and attach the documents and other evidences to support your complaint, if any.

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DETAILS OF INDIVIDUAL LODGING THE REPORT

Name
Designation
Department
Company
Telephone Number*
Email Address*

DECLARATION