Model Form for submission of communications to the Committee on Enforced Disappearances

The following model form provides guidance for those who wish to submit a communication for consideration by the Committee on Enforced Disappearance under Article 31 of the International Convention for the Protection of All Persons from Enforced Disappearance. Please provide relevant and pertinent information in response to the items listed below. Your communication should not exceed 50 pages (without annexes).

1. Information on the State party concerned

• Name of the State party (country) alleged to have committed the violation
• which is a party to International Convention for the Protection of All Persons from Enforced Disappearance and
• has made the declaration in accordance with Article 31 of the Convention

2. Information concerning the author(s) of the communication  

• Family name __________________ First name______________________
• Address of usual residence ___________________________
• Mailing address for confidential correspondence (if other than present address)
•   __________________________________________________
• Telephone/e-mail (if available) ___________________/_____________________
• If you are acting with the knowledge and consent of that person, please provide that person’s authorization for you to bring this complaint; or
• If you are not so authorized, please explain the nature of your relationship with that person: ____________________________________________________________ and detail why you consider it appropriate to bring this complaint on his or her behalf: ____________________________________________________________
• If you wish your identity not to be disclosed in the Committee’s final decision concerning your communication, please indicate it: __________________________

3. Information concerning the alleged victim(s)

If there is a group of individuals alleged to be victims, provide basic information about each individual.

• Family name __________________ First name______________________
• Sex ______________________
• Date of birth ____________________
• Place and country of birth ____________________
• Nationality (Nationalities) / citizenship ________________  
• Address of usual residence ___________________________
• If you wish the victim’s identity not to be disclosed in the Committee’s final decision concerning your communication, please indicate it: ___________________

If your communication refers to enforced disappearance of a person(s), also provide the following information about the victim(s), if available (optional):

• Other names, by which he or she may be known (if applicable/available) _________________________________________
• Profession/ Occupation/ Other relevant activity ____________________
• Father’s name _______________________
• Mother’s name _______________________
• If relevant, ethnic background, belonging to an indigenous people or a minority, religious affiliation, membership in political or social group _______________________________
• Identity Document (passport, national identity card, voter’s card or any other relevant national identity card)
• Was the person below 18 years-old at the moment of the disappearance?
•   _____yes / ______ no
• Marital Status / Children ______________ / ___________________
• Pregnant   ________ yes / ________ no. If yes, please specify if possible the number of months at the time of disappearance ____

4. Facts of the communication and articles violated

• Please detail, in chronological order, the facts and circumstances of the alleged violations. Include all matters which may be relevant to the assessment and consideration of your particular case.
• If possible, identify the articles of the Convention alleged to have been violated.
• Explain how you consider that the facts and circumstances described violated rights of the Convention. If the communication refers to more than one provision, describe each issue separately.

Important: Please note that it is highly recommendable to enclose copies of relevant documentation pertinent to your claims. DO NOT SEND ORIGINALS

If your communication refers to enforced disappearance of a person(s), include the following information as part of the facts (if possible):

1. Date of arrest, abduction or disappearance
2. Place of arrest, abduction or where the disappearance occurred (be as precise as possible. Indicate street, city, province or any other relevant information)
3. Date when the person was last seen, if different from date of arrest or abduction (for example: if seen in a prison months after the initial arrest or abduction)
4. Place where the person was last seen (if different from place of arrest or abduction. For example: if seen in a prison months after the initial arrest or abduction. Please, be as precise as possible. Indicate street, city, province or any other relevant information)
5. If possible, please, provide a full description of how the disappearance took place
6. Identity, if possible, State or State-supported forces, entity, or group believed to be responsible for the disappearance.

   i. If the perpetrators are believed to be State agents, please specify and indicate who and why they are believed to be responsible. Be as precise as possible -military, police, persons in uniform or civilian clothes, agents of security services, unit to which they belong, rank and functions, identifications presented, etc.-.

   ii. If identification as State agents is not possible, specify and indicate which group or entity is believed to be responsible. Please indicate if its members acted with the authorization, support or acquiescence of the State. Explain why you believe that Governmental authorities, or persons linked to them, may be responsible for the incident.

7. Additional Information on the case. Please indicate any other relevant information that could be useful.

5. Exhaustion of effective available domestic remedies

Describe the action taken by or on behalf of the alleged victim(s) to obtain redress within the State concerned for the alleged violations. For example, administrative and/or legal proceedings, 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)

Outcome/result (if any)

Domestic remedies need not be exhausted if their application would be unduly prolonged, if they would not be effective, if they are not available to you. If you have not exhausted domestic remedies for these reasons, or for any other, please explain them in detail.

Important: Enclose copies of all relevant documentation (e.g. administrative or court decisions). DO NOT SEND ORIGINALS

6.  Application to other international procedures

Have you submitted the same matter for examination under another procedure of international investigation or settlement (e.g. the Human Rights Committee, the Committee against Torture, or other Committees which monitor the implementation of core international human rights treaties; or regional mechanisms such as the Inter-American Commission on Human Rights, the Inter-American Court of Human Rights the European Court of Human Rights, the African Commission on Human and People’s Rights or the African Court on Human and People’s Rights)?

If so, please detail

• Which procedure(s) have been, or are being, pursued
• Which claims you have made
• When you submitted your complaint
• Which was the outcome (if any)

Important: Enclose copies of relevant documentation (e.g. your submission, the final outcome). DO NOT SEND ORIGINALS

7. Request for interim measures (optional)

You must indicate expressly if you wish the Committee to request interim measures from the State concerned to prevent irreparable damage to the victim of the alleged violation. In that case:

- describe the victim’s personal risk;

- identify the possible irreparable damage;

              - if possible, indicate the measure(s) that could be taken by the State concerned in order to avoid possible irreparable damage.

8. Date and signature

Date/place: _____________________________

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

_______________________________________

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

Author(s) of a communication are required to make sure, before sending the communication form, that all the above mentioned required elements are included.  This will allow for a smoother consideration of the case.

Send your communication to:

Petitions and Inquiries Section

Office of the United Nations High Commissioner for Human Rights (OHCHR)

United Nations Office at Geneva

1211 Geneva 10, Switzerland

Fax: +41 22 917 90 22

E-Mail: petitions@ohchr.org