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MDPPACPB Regulations

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7. Address or Known Contact: ______________________________________ 
8. Sector/Segment Involved: _______________________________________ 
Section C: Description of Alleged Conduct 
9. Detailed description of the alleged anti-competitive conduct: 
   ____________________________________________________________ 
   ____________________________________________________________ 
   Include dates, locations, relevant transactions or contracts involved. 
Section D: Legal and Regulatory Breach 
10. Identify the provision(s) of the Competition Regulation or PIA allegedly 
breached: 
   ____________________________________________________________ 
Section E: Supporting Evidence 
11. List and attach any supporting documentation or evidence: 
   ☐ Emails   ☐ Contracts   ☐ Price Lists   ☐ Market Reports   ☐ Other: ___________ 
Section F: Confidentiality and Whistleblower Declaration 
12. Do you wish to remain anonymous? 
   ☐ Yes   ☐ No 
13. Do you request confidential treatment of any submitted documents? 
   ☐ Yes   ☐ No — If yes, specify documents and reasons: 
   ____________________________________________________________ 
Section G: Declaration 
I declare that the information provided above is true and correct to the best 
of my knowledge. 
Signature: ________________________     Date: ______________________ 
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SCHEDULE 3 
Regulation 100 
 
SCHEDULE ON PENALTIES TABLE ON ANTI-COMPETITIVE CONDUCT. (To be used 
for Regulation 100 under Part XVII of these Regulations)