Whistle-blower E-form

Particulars of Complainant

(* Mandatory Field)

Name

Employee No.

NRIC No.

Position

Location (if applicable)

Department

Email Address

Contact No.

Correspondence Address

Particulars of Complaint

Name of person(s) Alleged

Position (if known)

Department (if known)

Relationship between you and the person alleged

Are you personally affected by the Improper Conduct / Detrimental Action

If NO, please state the particulars of the person(s) affected by the Improper Conduct Detrimental Action

Name of person(s) Alleged

Position (if known)

Department (if known)

Relationship between you and the person alleged

Allegation Details

Date

Time

Place

Estimated Value Involved

Description / Particulars

Have you previously made a Complaint of the Improper Conduct/Detrimental Action to any internal or external party or the authorities?

If YES, please provide the following particulars

Complaint/File Reference No. (if known)

Name of party or authority receiving the complaint

Position (if applicable)

Department (if applicable)

Date the complaint was made

Current status of the complaint

* I hereby declare that all the information provided in this Form, to the best of my knowledge is true & accurate.* I have read and understand Dialog Group Berhad's Whistle-blowing Policy.

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Whistle-blower Form

Particulars of Complainant

Particulars of Complaint

Allegation Details