Malaysian Communications And Multimedia Commission (MCMC) | Suruhanjaya Komunikasi dan Multimedia Malaysia (SKMM)

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A. PERSONAL INFORMATION OF WHISTLEBLOWER

Identification Card No:

Gender:

Race:

Mailing Address:

Email:*

Occupation:

Employer Name:

Employer Address:

B. DETAILS OF INDIVIDUAL INVOLVED IN IMPROPER CONDUCT

Name of the personnel:*
(if known)

Identification Card No:
(if known)

Designation of the personnel:
(if known)

Division/Department :
(if known)

Relationship between whistleblower and the personnel:

Details of Personnel 2

Name of the personnel 2:
(if known)

Identification Card No:
(if known)

Designation of the personnel:
(if known)

Division/Department :
(if known)

Relationship between whistleblower and the personnel:

Details of Personnel 3

(if known)

Identification Card No:
(if known)

Designation of the personnel:
(if known)

Division/Department:
(if known)

Relationship between whistleblower and the personnel:

C. PARTICULARS OF REPORT

Improper Conduct:

If Others (Please Specify):

Date:*

Today

Time:*

Location:*

Details of Incidence:*

Have you ever reported this improper conduct to other agencies?:*
If YES, please specify:

Yes
No

Ministry/Agency receiving the report:

Date Of Report (MM/DD/YYYY):

Today

Status of the reported case:(Other agencies)

Supporting Document

All documents should be uploaded either as a PDF / JPEG / JPG / Please ensure that the file size does not exceed 25MB. As an alternative, Whistleblower may email the supporting documents to wbc@mcmc.gov.my

I declare that all information provided in this form is true and I am willing to provide all the necessary assistance to ease the investigation process if required: *

Agree

Security code: *

Enter security code:

DISCLOSURE ON IMPROPER CONDUCT FORM

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