Vulnerability Disclosure Form

1. Reporter Information

Full Name *

National Identity Card/Passport Number*

Organisation

Email Address *

Contact Number *

Country *

Would you like to remain anonymous in public acknowledgements? *

2. Vulnerability Information

Name of Vulnerability

Type of Vulnerability

Date of discovery

Severity Level (if known)

Detailed Description of the Vulnerability

Steps to Reproduce the Vulnerability

Impact of the Vulnerability *

References (if related to known vulnerabilities such as CVE)

3. Affected System or Service

Is there any service or system affected by this vulnerability*

Affected Website / System or Application

URL or IP Address

Software / Product / Vendor

Version Number

4. Evidence and Supporting Information

Proof of Concept (such as code, scripts, or step-by-step instructions that confirm a reported security vulnerability is genuine and exploitable)

Screenshot

5. Disclosure Status

Has this vulnerability been reported elsewhere? *

Has the organisation/vendor already been notified? *

Has the vulnerability been publicly disclosed? *

Do you agree to follow responsible disclosure guidelines? *

6. Declaration and Ethical Commitment

I hereby declare and confirm that the reported vulnerability was identified through lawful, authorised, and ethical means. I further affirm that I have not conducted, nor attempted to conduct, any unauthorised scanning or testing of the affected system(s), and that I have not exploited, or attempted to exploit, the vulnerability for personal or third-party gain. I undertake to comply fully with CERT-MU's Coordinated Vulnerability Disclosure guidelines.

Vulnerability Disclosure Form

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