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The United Nations Human Rights Treaties |
Complaint Form to the Committee on the Elimination of Discrimination Against WomenNote: To be considered by the Committee, a communication: 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://www2.ohchr.org/english/law/cedaw-one.htm and http://www2.ohchr.org/english/bodies/petitions/index.htm
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........................................................................................................................................ Marital status/children.......................................................................................................... Profession….......................................................................................................................... Ethnic background, religious affiliation, social group (if relevant)...................................... Present address...................................................................................................................... ............................................................................................................................................... Mailing address for exchange of confidential correspondence (if other than present address).................................................................................................................................. 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).................................................................................................................................. Telephone/e-mail................................................................................................................... 3. Information on the State party concerned Name of the State party (country)........................................................................................ 4. Facts of the Complaint and nature of the alleged violation(s) Provide detailed information in chronological order, of the facts and circumstances of the alleged violations, 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 you have not exhausted domestic remedies on the ground that their application would be unduly prolonged, that they would not be effective, that they are not available to you, or for any other reason, explain your reasons in detail........................................................ .............................................................................................................................................. .............................................................................................................................................. 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. Disclosure of your name(s) Do you consent to the disclosure of your name(s) to the State party should your communication be registered by the Committee in accordance with article 6, paragraph 1 of the Optional Protocol and rule 69, paragraph 1 of the Committee’s rules of procedure?........................................................................................................................... 8. Date and signature Date/place:............................................................................................................................ Signature of author(s) and/or victim(s):............................................................................... 9. List of documents attached (do notsend originals, only copies) ............................................................................................................................................... ................................................................................................................................................
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