WHISTLEBLOWER FORM

You should raise any genuine concerns about any improper conduct or wrongful act ("Improper Conduct") in relation to Hong Leong Investment Bank Berhad. Concerns on your personal position or your employment, should be raised through HR grievance procedures, and not through this Whistleblower Form.

YOUR FULL NAME*
NAME OF YOUR EMPLOYER
YOUR STAFF ID (if an employee of HLIB)
YOUR DEPARTMENT
YOUR POSITION / DESIGNATION
YOUR CONTACT DETAILS	Address:	*Telephone:**
		*Email:**

DETAILS OF YOUR CONCERNS
(please provide as much information as possible)

DESCRIPTION OF IMPROPER CONDUCT*:
(use the additional information sheet, if neccessary)

WHERE DID THE IMPROPER CONDUCT OCCUR?*

WHEN DID THE IMPROPER CONDUCT OCCUR?*

NAME AND POSITION OF PERSON(S) INVOLVED:

DETAILS OF ANY WITNESS(ES):

DID YOU REPORT THE IMPROPER CONDUCT TO ANY AUTHORITIES? IF YES, PLEASE GIVE DETAILS:

ADDITIONAL INFORMATION SHEET

ANY ADDITIONAL INFORMATION:

Provide any further details you think may be relevant, for example, whether you approached the person(s) concerned, any financial impact to Hong Leong Investment Bank Berhad, etc.

* Required