Stamford Land Corporate Ltd

Date of submission of report: *

Time of report: *

A. Details of Incident(s)

Date of incident(s): *

Time of incident(s): *

Location of incident(s): *

Nature of incident(s): *

Name(s) of person reported on: *

Department(s) of person reported on: *

Description of incident: *

Further remarks:

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B. Particulars of Whistleblower

Name: *

Phone: *

NRIC NO.: *

E-mail Address: *

Address: *

C. Declaration

By submitting this form, I declare the above information are accurate and correct to the best of my knowledge. I also declare that I have provided these information in good faith and without any malicious intent. I am aware that my identity will be kept confidential unless otherwise required by law.