Whistleblower Report Form
Please provide the following details for any suspected serious misconduct or any breach or suspected breach of law or regulation (improper conduct) that may adversely impact Kinetic DAX Sdn. Bhd. (hereinafter referred to as ‘the Company’ or ‘Kinetic’). Please note that you may be called upon to assist in the investigation, if required.Note: Please follow the guidelines as laid out in the Anti-Bribery, Corruption and Whistleblowing Policy
REPORTER'S CONTACT INFORMATION
(This section may be left blank if the reporter wishes to remain anonymous)
Name
Designation
Department/Agency
Contact Number
*
Please enter a valid phone number.
E-mail Address
*
example@example.com
SUSPECT'S INFORMATION
Name
*
Designation
Department/Agency
*
Contact Number
Please enter a valid phone number.
E-mail Address
example@example.com
WITNESS'S INFORMATION (If any)
Name
Designation
Department/Agency
Contact Number
Please enter a valid phone number.
E-mail Address
example@example.com
COMPLAINT:
Briefly describe the improper conduct and how you know about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.
1. What improper conduct occurred?
*
2. Who committed improper conduct?
*
3. When did it happen and when did you notice it?
*
4. Where did it happen?
*
5. Is there any evidence that you could provide us?
6. Are there any other parties involved other than the suspect stated above?
7. Do you have any other details or information which would assist us in the investigation?
8. Any other comments?
Date
-
Day
-
Month
Year
Date
Signature
Continue
Continue
Should be Empty: