Submission of allegations to the Working Group on arbitrary detention of the United Nations

January 2011

[English] [français]

Working Group on arbitrary detention of the United Nations

MODEL QUESTIONNAIRE TO BE COMPLETED BY PERSONS ALLEGING ARBITRARY ARREST OR DETENTION

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:

II. Arrest

1. Date of arrest:

2. Place of arrest (as detailed as possible):

3. Forces who carried out the arrest or are believed to have carried it out:

4. Did they show a warrant or other decision by a public authority?

(Yes) ........ (No)......... 5. Authority who issued the warrant or decision:

6. Relevant legislation applied (if known):

III. Detention

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:

6. Reasons for the detention imputed by the authorities:

7. Relevant legislation applied (if known):

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

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

VI. Full name and address of the person(s) submitting the information (telephone and fax number, if possible)

Date:

Signature:

This questionnaire should be addressed to the

Working Group on arbitrary detention. Office of the High Commissioner for Human Rights, United Nations Office at Geneva, 8-14 avenue de la Paix, 1211 Geneva 10, Switzerland, fax No. (022) 917.90.06.

Thank you to send the following informations to the FI.ACAT office or to keep it informed.


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