WHISTLEBLOWER FORM
举报人表格

SECTION A: CONTACT INFORMATION

A部分：联系资料

NAME* / 姓名*：

NRIC No.* / 身份证号码*：

Contact No.:* / 联系电话*：

Email Address: / 电子邮件地址:

Employment Details (for employees only): / 就业详情（仅适用于员工）:

NAME / 姓名：

Department / 部门：

Position / 职位：

SECTION B: DISCLOSURE

B部分：披露内容

(a) Please include the details of the improper conduct, including the identity of the person alleged to be involved in improper conduct, the nature of the allegation and when the alleged improper conduct has taken place (use the additional information sheet, if necessary)
请提供不当行为的详细信息，包括涉嫌涉及不当行为的人员身份、指控的性质，以及该不当行为发生的时间（如有需要，可使用附加资料页）

(b) Please indicate the witness or evidence to substantiate your disclosure (if any) to facilitate the investigation. You may also attach relevant supporting documents (if any).
为便于调查，请说明可支持您披露事项的证人或证据（如有）. 您也可附上相关的支持文件（如有)

(c) Did you report the improper conduct to any authorities? If yes, please provide details of the
report.
您是否已向任何有关当局举报该不当行为？如有，请提供举报的详细信息.


Please attach your files here. (File Size Max 10MB)

SECTION C: DECLARATION
C 部分：声明


I hereby declare that all the information given herein are made voluntarily and are true to the best of my knowledge and I will ensure that my participation in this matter will be kept confidential. I do understand that Well Chip Group Berhad and its subsidiaries will use the information and material provided throughout the process. 本人在此声明，所提供的所有信息均为自愿提供，并据本人所知属实。本人将确保对此事项中的参与予以保密. 本人亦明白，大元集团有限公司及其子公司将在整个过程中使用所提供的信息和资料.