Whistleblowing Form

REPORTER DETAILS / BUTIRAN PELAPOR:

Full Name / Nama Penuh

IC Number/Staff/Student ID / No IC /No. Pekerja/ No. Pelajar

Address / Alamat

Town / Bandar(Daerah)

Postcode / Poskod

State / Negeri

Country / Negara

Phone No./ No. Telefon*

E-mail / E-mel

INCIDENT INFORMATION / BUTIRAN KEJADIAN:*

Type / Kategori*

Location of incident / Lokasi kejadian

Full Name (suspected to be involved) / Nama Penuh (yang disyaki terlibat)

ATTACHMENT / LAMPIRAN:

Evidence (Witness / document) / Bukti (Saksi / dokumen)

Captcha Validation

I acknowledge that the information provided in this form is true and correct.*

I also authorize UNITEN to process my personal data for the purposes of this complaint*