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

A.PERSONAL INFORMATION OF WHISTLEBLOWER

Name:

Identification Card No:

Gender:

Race:

Mailing Address:

Mobile Contact No.:

Email:*

Occupation:

Employer Name:

Employer Address:

B.DETAILS OF INDIVIDUALS 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

Name of the 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:

Improper Conduct:

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:

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

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