Whistleblower Form (1)This form is to be completed by person to who wishes to report any misconduct or suspected breach of code of ethics; laws and regulations; and company’s policies and procedures. Please note that you may be called upon to assist in the investigation, if required. Please enable JavaScript in your browser to complete this form. - Step 1 of 6Next Information on WhistleblowerName *IC Number / Passport Number *Contact Number *Email Address *Position / CompanyNext Information on Person AllegedName *Contact Number *Department / Unit *Position / Company *PreviousNext Information on Witness (If any)NameIC Number / Passport NumberContact NumberEmail AddressPosition / CompanyPreviousNext Details of AllegationsDate, time and location of misconduct / improper activity occurred?Date and time, you noticed the misconduct/ improper activity occurred? How it was detected?Describe the misconduct/ improper activity in detail. (Use additional sheet if needed)Who committed/involved with the misconduct/ improper activity?Reason why this offence is a concern / potential impact of allegation?Please provide evidence to support the allegation. Click or drag files to this area to upload. You can upload up to 5 files. Are you willing to provide any other details or information which would assist us in the investigation?Other comments?Have you raised your concern to any other person / department/ authority? (Tick whichever applicable)YesNoIf yes, please state the person/department/authority the report was made/lodged and insert the date of the report. You may attach a copy of the report made.PreviousNextDECLARATIONI hereby declare that all information given herein is made in good faith and voluntarily to the best of my knowledge and I will ensure that my participation in this matter will be kept confidential. I do understand that PAAB will use the information, document and material provided throughout the investigation process. I further agree that the information provided herein may be forwarded to a department/ authority/ enforcement agency for purposes of investigation. I fully understand that by signing this Form, I will be entitled to Whistleblower protection from the PAAB as set out in PAAB Whistleblowing Policy. I also fully understand that in the event I have made this report non-based allegations or in bad faith, the Whistleblower protection stated in PAAB Whistleblowing Policy will not be applicable to me and I may be subject to disciplinary or legal proceedings by PAAB. SignatureClear SignatureName *Date / TimeMessageSubmit Whistleblower Form (2)This form is to be completed by person to who wishes to report any misconduct or suspected breach of code of ethics; laws and regulations; and company’s policies and procedures. Please note that you may be called upon to assist in the investigation, if required. Please enable JavaScript in your browser to complete this form. - Step 1 of 5Information on WhistleblowerNameIC Number / Passport NumberContact NumberEmail AddressPosition / CompanyNextInformation on Person AllegedNameContact NumberDepartment / UnitPosition / CompanyNextInformation on Witness (If any)NameIC Number / Passport NumberContact NumberEmail AddressPosition / CompanyNextDetails of AllegationsDate, time and location of misconduct / improper activity occurred?Date and time, you noticed the misconduct/ improper activity occurred? How it was detected?Describe the misconduct/ improper activity in detail. (Use additional sheet if needed)Who committed/involved with the misconduct/ improper activity?Reason why this offence is a concern / potential impact of allegation?Please provide evidence to support the allegation. Click or drag files to this area to upload. You can upload up to 5 files. Are you willing to provide any other details or information which would assist us in the investigation?Other comments?Have you raised your concern to any other person / department/ authority? (Tick whichever applicable)YesNoIf yes, please state the person/department/authority the report was made/lodged and insert the date of the report. You may attach a copy of the report made.NextDECLARATIONI hereby declare that all information given herein is made in good faith and voluntarily to the best of my knowledge and I will ensure that my participation in this matter will be kept confidential. I do understand that PAAB will use the information, document and material provided throughout the investigation process. I further agree that the information provided herein may be forwarded to a department/ authority/ enforcement agency for purposes of investigation. I fully understand that by signing this Form, I will be entitled to Whistleblower protection from the PAAB as set out in PAAB Whistleblowing Policy. I also fully understand that in the event I have made this report non-based allegations or in bad faith, the Whistleblower protection stated in PAAB Whistleblowing Policy will not be applicable to me and I may be subject to disciplinary or legal proceedings by PAAB. SignatureClear SignatureNameDate / TimeWebsiteSubmit