INFORMATION ABOUT THE VICTIM 

First Name  
Last Name   
Name in arabic   
Current status  
Primary address   
Country of residence  
Situation of the victim's family  
Situation of the victim's family  
Document related to the victim
 Birthdate  
 Birthdate  MaleFemale
Nationality  
 Birthdate  
 Other relevant details about the victim  

Political activism, writing, blogging, past arrests, etc...

 

INFORMATION ABOUT THE SOURCE

Source first name
Source last name
Source phone number
Relation of the source to the victim
Email
Email - confirm
Do you have any concerns with the use of this information in ADHRB's work with the media?

 

TYPE OF VIOLATION

Type of violation Arbitrary detentionTortureDisappearanceSummary executionOther
What actions have been taken

Legal, contact with government, NGOs, media, etc...

 

IN CASE OF ARREST OR DETENTION

Date of arrest
Place of arrest (address, city, province)
Place of arrest (country)
Identity of arresting forces
Description of arrest
Where is the victim detained now?
Describe any legal procedures

 

IN CASE OF TORTURE

Description of torture
Location and dates of torture
If he was forced to make false confessions, were they used as evidence in court? When? Which court?
Medical report

 

IN CASE OF DISAPPEARANCE

Date of disappearance
Date of last contact with the victim
Place of last contact with the victim
Describe disappearance Location, forces, how it was carried out.
Are there any ideas where the victim may be detained?
Describe the execution
Were there any legal actions taken?

Autopsy, investigation, etc...

 

Comments or suggestions about this questionnaire