WHISTLEBLOWER REPORT FORM

Please provide the following details for any suspected serious misconduct or any breach or suspected breach of law or regulation that may adversely impact the Group. Please note that you may be called upon to assist in the investigation, if required.

REPORTER’S CONTACT INFORMATION

SUSPECT’S INFORMATION

WITNESSES’S INFORMATION (if applicable)

COMPLAINT : Briefly describe the misconduct / improper activity and how you know about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.