MODEL QUESTIONNAIRE TO BE COMPLETED BY PERSONS ALLEGING ARBITRARY

model questionnaire to be completed by persons alleging arbitrary arrest or detention1 i. identity 1. family name: ………………………………… 2

MODEL QUESTIONNAIRE TO BE COMPLETED BY PERSONS ALLEGING ARBITRARY
ARREST OR DETENTION1
I. IDENTITY
1. Family name: …………………………………
2. First name: ……………………………...……
3. Sex: (Male) (Female)
4. Birth date or age (at the time of detention): ………………………………………
5. Nationality/Nationalities:……………………………………………………………
6. (a) Identity document (if any): ………………………………………………………
(b) Issued by: ……………………………………………………………………………
(c) On (date): ……………………………………………………………………………
(d) No.: ……………………………………………………………………………………
7. Profession and/or activity (if believed to be relevant to the
arrest/detention):
……………………………………………………………………………………
……………………………………………………………………………………
8. Address of usual residence:
……………………………………………………………………………………
……………………………………………………………………………………
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II. Arrest2
1. Date of arrest:………………………………………………………………
2. Place of arrest (as detailed as possible):
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3. Forces who carried out the arrest or are believed to have carried
it out:
……………………………………………………………………………………
……………………………………………………………………………………
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4. Did they show a warrant or other decision by a public authority?
(Yes) ........ (No).........
5. Authority who issued the warrant or decision:
……………………………………………………………………………………
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……………………………………………………………………………………
6. Relevant legislation applied (if known):
……………………………………………………………………………………
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III. Detention3
1. Date of detention: …………………………………………………………………
2. Duration of detention (if not known, probable duration):
……………………………………
3. Forces holding the detainee under custody:
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
4. Places of detention (indicate any transfer and present place of
detention):
………………………………………………………………………………………………………………………………………………………………………………………………………
5. Authorities that ordered the detention:
……………………………………………………………………………………
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6. Reasons for the detention imputed by the authorities:
……………………………………………………………………………………
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7. Relevant legislation applied (if known):
……………………………………………………………………………………
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IV. Describe the circumstances of the arrest and/or the detention and
indicate precise reasons why you consider the arrest or detention to
the arbitrary 9/
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V. Indicate internal steps, including domestic remedies, taken
especially with the legal and administrative authorities, particularly
for the purpose of establishing the detention and, as appropriate,
their results or the reasons why such steps or remedies were
ineffective or why they were not taken
……………………………………………………………………………………
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VI. Full name and address of the person(s) submitting the information
(telephone and fax number, if possible) 4
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Date: …………………… Signature: ……………............……
1 A separate questionnaire must be completed for each case of alleged
arbitrary arrest or detention. As far as possible, all details
requested should be given. Nevertheless, failure to do so will not be
necessarily result in the inadmissibility of the communication.
2 For the purpose of this questionnaire, “arrest” refers to the
initial act of apprehending a person. “Detention” means and includes
detention before, during and after trial. In some cases, only section
II, or section III may be applicable. None the less, whenever
possible, both sections should be filled in.
3 For the purpose of this questionnaire, “arrest” refers to the
initial act of apprehending a person. “Detention” means and includes
detention before, during and after trial. In some cases, only section
II, or section III may be applicable. None the less, whenever
possible, both sections should be filled in.
4 If a case is submitted to the Working Group by anyone other than the
victim or his family, such person or organization should indicate
authorization by the victim or his family to act on their behalf. If,
however, the authorization is not readily available, the Working Group
reserves the right to proceed without the authorization. All details
concerning the person(s) submitting the information to the Working
Group, and any authorization provided by the victim or his family,
will be kept confidential.