INTEGRITY MISCONDUCT COMPLAINT FORM

SECTION A – COMPLAINANT INFORMATION (MAKLUMAT PENGADU)

1. FULL NAME (NAMA PENUH) :

2. I/C NUMBER (NO K/P):

3. DEPARTMENT (JABATAN):

4. MOBILE PHONE NUMBER (NO H/P):

5. OFFICE PHONE NUMBER (NO TEL. PEJABAT):

6. POSITION (JAWATAN):

7. E-MAIL(EMEL):

8. ADDRESS (ALAMAT):

9. POSTCODE (POSKOD):

10. DATE (TARIKH):

BAHAGIAN B – MAKLUMAT ADUAN

1. TYPE OF OFFENSE (JENIS KESALAHAN):

2. DATE OF OFFENSE (TARIKH KEJADIAN):

3. DAY OF OFFENSE (HARI KEJADIAN):

4. TIME OF OFFENSE (MASA KEJADIAN):

5. PLACE OF OFFENSE (TEMPAT KEJADIAN):

6. NAME(S) OF PERSON(S) INVOLVED (NAMA-NAMA ORANG YANG TERBABIT DALAM KEJADIAN):

7. WITNESS(ES) WHO KNOWS / SAW THE OFFENSE (SAKSI-SAKSI YANG MENGETAHUI / MELIHAT KEJADIAN):

8. REFERENCE OF RELATED ACTS / DOCUMENT (RUJUKAN AKTA/DOKUMEN YANG BERKAITAN):

9. AMOUNT OF MONEY / GOODS / SERVICES (JUMLAH WANG/BARANGAN/PERKHIDMATAN):

10. BRIEF DESCRIPTION OF THE OFFENSE (INCLUDING ANY OTHER REFERENCES SUCH AS VEHICLE PLATE NUMBER, RECEIPT NUMBER, ACCOUNT NUMBER, IDENTITY AND OTHERS. (KETERANGAN RINGKAS KEJADIAN (TERMASUK SEBARANG RUJUKAN LAIN SEPERTI NO KENDERAAN, NO RESIT, NO AKAUN, IDENTITI DAN SEBAGAINYA JIKA ADA)):

INTEGRITY MISCONDUCT COMPLAINT FORM

SECTION A – COMPLAINANT INFORMATION (MAKLUMAT PENGADU)

BAHAGIAN B – MAKLUMAT ADUAN

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