WHISTLEBLOWING FORM

WHISTLEBLOWING FORM
This form may be used by any person covered under the Whistleblowing Policy to report suspected misconduct, wrongdoing, or violations of MPABD’s Code of Conduct and Ethics Guidelines, policies, or applicable laws.
It may be submitted through any of MPABD’s designated Whistleblowing Channels as set out in Section 7 (Reporting Channels) of MPABD’s Whistleblowing Policy, including:

a)Direct submission to a Whistleblowing Officer (WBO);b)Submission via email to YourVoice@mpabd.gov.bn;c)Submission via MPABD’s website (www.mpabd.gov.bn), which provides links to the designated whistleblowing email addresses;d)Submission via the confidential mailbox at Ground Floor, back door entrance at MPABD HQ.

All reports submitted through any of the above Whistleblowing Channels will be handled in a confidential manner and in accordance with the Whistleblowing Policy.

Whistleblowers may choose to remain anonymous. However, anonymous reporting may limit MPABD’s ability to seek clarification or conduct a full investigation. The Whistleblowing Helpline may also be used to seek guidance or assistance in making a report, but formal reports should be submitted through the Whistleblowing Channels above.

Unless otherwise defined in this form, capitalised terms used herein have the meanings given to them in the Whistleblowing Policy.

- Person(s) or entity alleged to have engaged in misconduct.•If more than one (1) person, please attach additional tables separately to this form.•If any of the fields is not known, leave blank.
- Name
- Designation / Position
- Division/ Department/ Company (If applicable)
- Relation to MPABD (IF ANY)
- Contact Number
- Email Address
- Please provide as much detail as possible to assist in assessment and investigation.
- What happened?(Describe the nature of the misconduct, wrongdoing or attempted misconduct / wrongdoing)
- What happened?(Dates and times, if known)
- Where did it occur?(Location / Department)
- Who else was involved or may have relevant knowledge?(e.g., witnesses, other person(s) connected to the incident)
- How did you become aware of the matter? (Yes/No - if yes, please specify)
- Please list or attach any supporting evidence that may assist in verifying the report (e.g., emails, documents, photographs, or witness names).•Attach additional pages to this form separately if necessary.•If no supporting evidence is available, please state ‘None’.
  
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- Do you wish to remain anonymous?
- If “No”, may MPABD contact you for clarification?
- Preferred method of contact(if applicable)
- Leave blank if you wish to remain anonymous.If you wish to be informed of the outcome or closure of the case (where practicable and subject to confidentiality considerations, please provide your contact details. All information provided will be treated with strict confidentiality at all times.
- Name
- Designation/ Relationship to MPABD
- Division / Department / Company (if applicable)
- Contact Number
- Email Address
- DECLARATION
  
  Leave blank if you wish to remain anonymous.
- Name
- Date
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
- Signature
Should be Empty:

WHISTLEBLOWING FORM

DECLARATION