New Leniency Form

Leniency Form

SECTION A1 : THE APPLICANT

Name:*

Company Name:*

ROCBN:*

Address:*

Phone Number:*

Email Address:*

Website:*

Are you representing an organization (e.g. company, association, partnership, or society) in making this leniency application?:*

Yes No

SECTION A2 : ORGANIZATION DETAILS

Name of the organization you represent:*

Company Registration No.:

Address:

Contact Number:*

Fax Number:

Email Address:

Website:

SECTION B1 : DETAILS OF OTHER PARTIES WHO MAY BE INVOLVED

Details of Other Parties:

Index	Person Involved	Company Name	Role of Party	Contact No.	Address	Email Address	Website
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SECTION B2 : DESCRIPTION OF ANTI-COMPETITIVE ACTIVITY

Nature of anti-competitive activity complained against:*

Please Specify:

What are the goods or services to which the anti-competitive activity relates?:*

Geographical scope of the anti-competitive activity:*

Please describe briefly the anti-competitive activity that you or the organization you are representing involve in. Provide as much details as possible of the activity including how the agreement is initiated, strategized, formulated and implemented:*

When did this anti-competitive activity start?:*

Is this anti-competitive activity still continuing?:*

Yes No

When did this anti-competitive activity end?:*

Additional Information:*

SECTION C : FILE ATTACHMENT

Please submit letter of authorization proving the representative's authority to act on behalf of the organization (if relevant) (please upload in .jpg, .jpeg, .pdf and .png format and size must not exceed 20MB):

Index	Filename
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Add Letter of Authorization:

Please list all evidence supporting your application and submit relevant documents (e.g. agreements, minutes of meetings, business documents, circulars, correspondence, note of telephone conversation etc):*

Please attach all evidence supporting your complaint and submit relevant documents (e.g. agreements, minutes of meetings, business documents, circulars, correspondence, note of telephone conversation etc.)

(please upload in .docx, .xlsx, .jpg, .jpeg, .png, .bmp, .gif, .mp4, .mp3, .mpeg and .pdf format and size must not exceed 20MB)

Index	Filename
{{index + 1}}

Add Evidence File:

Information submitted in this form will be restricted and treated accordingly, as per Section 70 on Preservation of Secrecy of the Competition Act.
Pursuant to Section 70(4) of the Act, clearly identify any confidential information and explain why this information should be treated as confidential. Please refer to CCBD Guidelines on Applying for Confidential Treatment for more information and guidance.

SECTION D : DECLARATION

I declare that the information I have submitted in the Complaint Form is true and correct to the best of my knowledge and belief.

I understand that it is an offence to provide false and misleading information to the CCBD.

Information provided in this form will be treated restricted and treated accordingly, as per Section 70 on Preservation of Secrecy of the Competition Act.