PT Centratama Telekomunikasi Indonesia, Tbk

Whistle-Blowing Disclosure Form

Please provide the following details for any suspected improper conduct or any breach or suspected breach of law or regulation that may adversely impact Centratama Telekomunikasi Indonesia Tbk & its Group of Companies.

Anti-Retaliation Information

Centratama Group prohibits any retaliatory action against the Whistle-Blower and will not tolerate any harassment, nor victimisation of a Whistle-Blower. If a Whistle-Blower believes that he/she has been subjected to retaliatory actions by any person(s), the Whistle-Blower may report his/her grievances to the Centratama Group Compliance Department or to the Compliance Officer of the relevant Centratama Group Company.

Your Contact Information

Employee Details (for Centratama Group employees only)

Disclosure / Details Of Incidents


1. Details relating to Improper Conduct

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? *

2. Individuals involved

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: *

3. Evidence

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

4. Others

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


5. Previous reports

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

6. Risk

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

7. Discouragement

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

Disclosure / Details Of Incidents

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.

Our Office

TCC Batavia Tower One 16th & 19th Floor

Jl. KH. Mas Mansyur Kav. 126 Jakarta Pusat

DKI Jakarta 10220 Indonesia

Phone: +62 21 2952 9404

Email: cti@centratamagroup.com

Customer Care: 1500 251

Helpdesk: helpdesk@centratamagroup.com