Please provide as much detail as possible: e.g. What happened? When did it occur? (Past/ Present/ On-going) What type of breach/ improper conduct? How did you become aware of this? *

Name of the person involved in the breach/improper conduct: *

List the names of ALL other individuals involved, or who may be aware of this allegation (e.g. any witnesses to the event).

Entity that the breach/improper conduct occurred in: *

Please provide evidence to substantiate your disclosure (if any) to facilitate investigation. You may also attach the relevant supporting documents. *

Do you have any other details or information which would assist us in the investigation?                                                          

Have you reported this previously? If so, what, when, and to whom? What action did they take?

Are there any risks to you and/or others? *                                                             

Has anyone tried to hide this, or tried to discourage you from sharing your concerns? If so, please tell us who and how?

I hereby declare that all the information furnished herein are made voluntarily and are true to the best of my knowledge and in good faith, free from any malicious intent. I acknowledge that Centratama Telekomunikasi Indonesia Tbk & its Group of Companies reserves the rights to use the information and material provided strictly for the purpose of acting on this disclosure.