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Whistleblower Form
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.
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Information on Whistleblower
Name
*
IC Number / Passport Number
*
Contact Number
*
Email Address
*
Position / Company
Information on Person Alleged
Name
*
Contact Number
*
Department / Unit
*
Position / Company
*
Information on Witness (If any)
Name
IC Number / Passport Number
Contact Number
Email Address
Position / Company
Details of Allegations
Date, 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)
Yes
No
If 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.
DECLARATION
I 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.
Signature
Clear Signature
Name
*
Date / Time
Name
Submit
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