The United Nations Human Rights Treaties

must be in writing;
may not be anonymous;
must refer to a State which is a party to both the Convention on the Elimination of All Forms of Discrimination against Women and the Optional Protocol;

must be submitted by, or on behalf of, an individual or a group of individuals under the jurisdiction of a State which is a party to the Convention and the Optional Protocol. In cases where a communication is submitted on behalf of an individual or a group of individuals, their consent is necessary unless the person submitting the communication can justify acting on their behalf without such consent.

A communication will not normally be considered by the Committee:

unless all available domestic remedies have been exhausted;
where the same matter is being or has already been examined by the Committee or another international procedure;
if it concerns an alleged violation occurring before the entry into force of the Optional Protocol for the State.

In order for a communication to be considered the victim or victims must agree to disclose her/their identity to the State against which the violation is alleged. The communication, if admissible, will be brought confidentially to the attention of the State party concerned.

If you wish to submit a communication, please follow the guidelines below as much as possible. Also, please submit any relevant information which becomes available after you have submitted this form.

Further information on the Convention on the Elimination of All Forms of Discrimination against Women and its Optional Protocol, as well as the rules of procedure of the Committee can be found at: http://www.un.org/womenwatch/daw/cedaw/index.html

The following questionnaire provides a guideline for those who wish to submit a communication. Please provide as much information as available in response to the items listed below. Attach additional pages as necessary.

1. Information concerning the author of the communication

Family Name ................................................................................................................................

First name(s).................................................................................................................................

Date and place of birth...................................................................................................................

Nationality/citizenship....................................................................................................................

Passport/identity card number (if available)...................................................................................

Sex...............................................................................................................................................

Profession .....................................................................................................................................

Ethnic background, religious affiliation, social group (if relevant)...................................................

Present address..............................................................................................................................

......................................................................................................................................................

Mailing address for exchange of confidential correspondence (if other than present address) ......................................................................................................................................................

Fax/telephone/e-mail......................................................................................................................

Indicate whether you are submitting the communication as:

(a) Alleged victim(s). If there is a group of individuals alleged to be victims, provide basic information about each individual..................................................................................................

(b) On behalf of the alleged victim(s). Provide evidence showing the consent of the victim(s), or reasons that justify submitting the communication without such consent.......................................

2. Information concerning the alleged victim(s) (if other than the author)

Family name..................................................................................................................................

First name......................................................................................................................................

Date and place of birth...................................................................................................................

Nationality/citizenship....................................................................................................................

Passport/identity card number (if available)....................................................................................

Sex................................................................................................................................................

Marital status/children...................................................................................................................

Profession......................................................................................................................................

Ethnic background, religious affiliation, social group (if relevant)...................................................

Present address..............................................................................................................................

.....................................................................................................................................................

Mailing address for confidential correspondence (if other than present address)............................

......................................................................................................................................................

Fax/telephone/e-mail.....................................................................................................................

3. Information on the State party concerned

Name of the State party (country).................................................................................................

4. Nature of the alleged violation(s)

Provide detailed information to substantiate your claim, including:

Description of alleged violation(s) and alleged perpetrator(s).............................................
Date(s)..............................................................................................................................
Place(s).............................................................................................................................
Provisions of the Convention on the Elimination of All Forms of Discrimination against Women that were allegedly violated. If the communication refers to more than one provision, describe each issue separately.
................................................................................................
................................................................................................
................................................................................................

5. Steps taken to exhaust domestic remedies

Describe the action taken to exhaust domestic remedies; for example, attempts to obtain legal, administrative, legislative, policy or programme remedies, including:

Type(s) of remedy sought..................................................................................................
Date(s)..............................................................................................................................
Place(s)..............................................................................................................................
Who initiated the action.....................................................................................................
Which authority or body was addressed.............................................................................
Name of court hearing the case (if any).............................................................................

If domestic remedies have not been exhausted, explain why.

......................................................................................................................................................

Please note: Enclose copies of all relevant documentation.

6. Other international procedures

Has the same matter already been examined or is it being examined under another procedure of international investigation or settlement? If yes, explain:

Type of procedure(s).........................................................................................................
Date(s)...............................................................................................................................
Place(s)..............................................................................................................................
Results (if any)...................................................................................................................

Please note: Enclose copies of all relevant documentation.

7. Date and signature

Date/place:....................................................................................................................................

Signature of author(s) and/or victim(s):.........................................................................................

8. List of documents attached (do not send originals, only copies)

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