Print and fax it to MyCERT at 

General Information
   1  Incident number (to be assigned by MyCERT).................:
   2  Reporting site information
      2.1  Name of Organization... ..................................................:
      2.2  Name of Domain (e.g., mycert.mimos.my).......................:

Contact Information
   1  Your contact information
      1.1  Name..........................................................................:
      1.2  E-mail address.............................................................:
      1.3  Telephone number......................................................:
      1.4  FAX number...............................................................:

Incident Categories
 1 Please indicate the incident catagories
      1.1  Nework Abuse
                 1.1.1  Intrusion......................................................:
                 1.1.2  Destruction.................................................:
                 1.1.3  Denial of service attack..............................:
                 1.1.4  Hack Threat................................................:
                 1.1.5  Probe/Scan.................................................:
                 1.1.6  Spoofing.....................................................:
      1.2  Email Abuse (please provide the full header)
                 1.1.1  Mailbomb...................................................:
                 1.1.2  Virus...........................................................:
                 1.1.3  Email Forgery.............................................:
                 1.1.4  Harrassment................................................:
                 1.1.5  Spamming...................................................:
                 1.1.6  Others.................................(please specify):

Detail description of the incident
   1  Please complete in as much detail as possible
      1.1  Suspected date and time of attack.............................:
      1.2  Suspected method of intrusion (e.g., name of virus,
                name of exploit script, etc.).....................................:
      1.3  How you discovered the incident...............................:
      1.4  The source of the attack (if known)............................:
      1.5  Steps taken to address the incident (e.g.,
             binaries reinstalled, patches applied)........................:
      1.6  Planned steps to address the incident (if any)............:
  2  Please append any log information or directory listings
        and time zone information relative to GMT to the end of
        this document...................................................................:

Other information
   1  What assistance would you like from MyCERT...............:
   2   Would you allow MyCERT to reveal your contact info...:
   3  Any additional information................................................: