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Whisteblowing Form

Important Notice
While all reporting of improper conduct in good faith and not for malicious intent will be investigated, a Whistleblower is encouraged to identify himself/herself when reporting, for credibility purposes and to allow an avenue for CUCKOO to follow up to ascertain the facts or to obtain further information for investigation purposes. Please attach reliable evidence to substantiate your disclosure and assist in the investigation. You may use additional sheets for additional witnesses or supporting evidence if necessary.

Part A: Disclosure Details

Name of person(s) involved in the incident or issue.

Department/Designation:

If money is involved, please indicate the amount involved.

Do you suspect any other people that are involved? Please provide the details, if any.

Do you suspect that the management is involved? Please provide the details, if any.

Have you notified anyone? Please provide the details, if any.

Any witness? Please provide the name, department and other relevant details.

Date, Time and Location of the incident or issue?

How did you discover the incident or issue?

Please provide a description of the incident or issue.

Part B: Whistleblower Details

Are you an employee of CUCKOO?

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Contact Number (Mandatory)

Email Address (Mandatory)

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