Torture and Human Rights Violations should be REPORTED to both the appropriate UN oversight body, and to the local Government in which it occurred, reporting here is not a substitute for an official appropriate report. We are NOT UN nor Government affiliated. However, as an NGO we may undertake our own private Investigation(s) and provide Chaplaincy service to the victim(s) when possible. We would appreciate your report using the following form:

Torture Report

Your name

First

Last

You may remain anonymous by leaving blank.

Your Email

You may remain anonymous but we would appreciate being able to follow up.

Torture Victim's name *

First

Last

If full name unknown, write "unknown" in field.

Victim's age

If known. or approximate age.

Country *

Country, State or City where Torture or Human Rights Violation occured.

Date of Incident

Date

Time

on or about - approximate.

What are you Reporting? *

• Torture
• Hunan Rights Violation
• Death
• Imminent Risk of Torture or Death

Check all that applies.

Place or Location of Incident

• Prison or Jail
• Police or Government Custody
• 3rd Party or Private Custody
• Work Place
• Home
• Public Area

Check any that apply.

List the Perpetrators

Give names if known? Descriptions and who they were if known.

List those Present

List or Describe any witnesses. Indicate your self too if you were there.

Your Source

Witness, News, Friend, so forth...

Relevant URL

News, social media, so forth...

Background Context *

Please describe the context leading up to the Torture or Human Rights Violation. Victim was a Dissident? Activist? News Reporter? Researcher? Arrested? Kidnapped? Project victim was undertaking? so forth...

Describe Torture and Human Rights Violation *

Method of Torture? Details? Psychological? Physical? Restraint? Threats? Bruises? Broken Bones? so forth...

Photo Upload

Click or drag files to this area to upload. You can upload up to 2 files.

Upload up to 2 photos. Photos should include. 1. Photo of the victim tortured. 2. Photo of the torture or injury.

Did the victim receive medical treatment?

• Yes
• No
• Unknown
• Injuries Documented

Additional comments

GDPR Agreement *

• I consent to having this website store my submitted information.

Declaration

• I declare under penalty of perjury that the foregoing is true and correct

Leave Blank if Anonymous

Executed on

Date

Time

Leave Blank if Anonymous

Your Signature

Clear Signature

Leave Blank if Anonymous

Submit