NGO SUBMISSIONS FOR ANNUAL REPORT 2016
FORB VIOLATIONS: SUBMISSIONS PROTOCOL
Please fill in the questionnaire below to submit any specific FoRB violation cases to the secretariat: firstname.lastname@example.org
Please include in the subject box: ‘Report of FoRB violation’.
1. GENERAL INFORMATION about the FoRB violation
Does the incident involve an individual or a group? If it involves a religious or belief group please state the number of people involved and the denomination of the group: Country(ies) in which the incident took place.
2. IDENTITY OF THE PERSONS CONCERNED
His/her religion or belief
Place of residence or origin
3. INFORMATION REGARDING THE ALLEGED VIOLATION
Description of the violation
Date and time (approximate, if exact date is not known)
Bias motivation indicators because of his/her religion or belief?
Identification of the alleged perpetrator(s), name(s) if known and/or function, suspected motive
Are the perpetrator(s) known to the victim?
Was the violation as a result of state agents or non-state-actors?
4. STEPS TAKEN BY THE VICTIM, HIS/HER FAMILY OR ANYONE ELSE ON HIS/HER BEHALF?
Please indicate if complaints have been filed, when, by whom, and before which State authorities or competent bodies (i.e. police, prosecutor, court).
5. IDENTITY OF THE PERSON OR INSTITUTION SUBMITTING THIS FORM
Contact number or address (please indicate country and area code):
Please state whether you want your identity to be kept confidential:
Date you are submitting this form: Signature: ______________________________