Malaysia Building Society Berhad

Complaint Against*

Name*

Staff ID (if applicable)

NRIC No.

Office No.

Mobile No.*

E-mail Address*

Nature of Alleged Misconduct *

Date of incident*

Time of incident*

Place of Alleged Incident*

Name of Person(s) Involved *

Designation of the Person(s) Involved

Details of the Alleged Misconduct *

Witness (if any)

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I hereby declare that all the information furnished herein are made voluntarily and are true to the best of my knowledge, in good faith and free from any malicious intent.

I acknowledge and agree that MBSB reserves the rights to use the information and material provided strictly for the purpose of acting on this disclosure.

For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all data you had disclosed to MBSB in this Form.

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