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Special Rapporteur on extrajudicial, summary or arbitrary executions - Model Questionnaire
General Informations  

The Special Rapporteur undertakes action in the following cases:

(a) Violations of the right to life in connection with the death penalty. The Special Rapporteur intervenes when capital punishment is imposed after an unfair trial, or in case of a breach of the right to appeal or the right to seek pardon or commutation of sentence. He also intervenes if the convicted is a minor, a mentally retarded or insane person, a pregnant woman or a recent mother;

(b) Death threats and fear of imminent extrajudicial executions by state officials, paramilitary groups, private individuals or groups cooperating with or tolerated by the Government, as well as unidentified persons who may be linked to the categories mentioned above;

(c) Deaths in custody owing to torture, neglect or the use of force, or life-threatening conditions of detention;

(d) Deaths owing to the use of force by law enforcement officials, or persons acting in direct or indirect compliance with the State, when the use of force is inconsistent with the criteria of absolute necessity and proportionality;

(e) Deaths owing to attacks by security forces of the State, by paramilitary groups, death squads or other private forces cooperating with or tolerated by the Government;

(f) Violations of the right to life during armed conflicts, especially of the civilian population, contrary to humanitarian law;

(g) Expulsion or refoulement of persons to a country where their lives are in danger;

(h) Genocide;

(I) Breach of the obligation to investigate alleged violations of the right to life and to bring those responsible to justice;

(j) Breach of the obligation to provide adequate compensation to victims of violations of the right to life.
 

Address:
 

Reports of extrajudicial, summary or arbitrary executions may be transmitted to the following address:
 

Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions
c/o OHCHR-UNOG, 1211 Geneva 10, Switzerland
Fax: (+41 22) 917 90 06
 

or e-mailed to:
  E-mail: urgent-action@ohchr.org
 
 
 

Note: If any information contained in the questionnaire should be kept confidential please mark "CONFIDENTIAL" beside the relevant entry. Do not hesitate to attach additional sheets, if the space provided is not sufficient.
 
 
 

I. Identity of the person concerned:

Note: if more than one person is concerned, please fill out separate questionnaires for each person
 

1. Family name:.........................................................................................................................................

2. First name:............................................................................................................................................

3. Sex: __ male __ female

4. Birth date or age:..................................................................................................................................

5. Nationality(ies):.....................................................................................................................................

6. Civil status (single, married, etc.):

7. Identity document:........................................ .......................................................................................

Nr.:........................................................................................................................................................

Issued by:...............................................................................................................................................

Date of issue:...........................................................................................................................................

8. Profession and/or activity (e.g. trade union, political, religious, humanitarian/solidarity/human rights, etc.) ..............................................................................................................................................................

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9. Address of usual residence:.....................................................................................................................

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10. Is there a link to other cases/ persons? Please specify:

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II. Information regarding the incident:
 

1. Date:.................................................................................................................................................

2. Place:................................................................................................................................................

3. Time:.................................................................................................................................................
 

4. The nature of the incident: Please describe the circumstances of the incident, including the following categories:

(a) death penalty, or fair trial guarantees, please detail (unfair laws or proceedings, charges, eventual appeals, execution is imminent, etc.)

(b) imminent violation of the right to life is feared (death threats, imminent expulsion or refoulement leading to a life-threatening situation, etc.), please detail.

(c) others (death in custody, death during an armed conflict, death due to excessive use of force by law enforcement officials, death due to attacks by security forces of State, paramilitary or private forces, breach of obligation to investigate, etc.): ............................................................................................................................................................

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III. Forces believed to be responsible for the incident:
 

(a) if the perpetrators are believed to be State agents, please specify (military, police, persons in uniform or civilian clothes, agents of security services, unit to which they belong, rank and functions, etc.) and indicate why they are believed to be responsible; be as precise as possible: ...............................................................................................................................................................

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(b) if an identification as State agents is not possible, why do you believe that Government authorities, or persons linked to them, are responsible for the incident?

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(c) if there are witnesses to the incident, indicate their names. If they wish to remain anonymous, indicate if they are relatives, by-passers, etc.; if there is evidence, please specify:

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IV. Steps taken by the victim or his/her family:
 

(a) Indicate if complaints have been filed, when, by whom, and before which organ.

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(b) Other steps taken:

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V. Steps taken by the authorities:
 

(a) Indicate whether or not there have been investigations by the State authorities; if so, what kind of investigations? Progress and status of these investigations; which other measures have been taken (e.g. autopsy)?

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(b) in case of complaints by the victim or its family, how have the organs dealt with them? What is the outcome of those proceedings?

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  VI. Identity of the person submitting the case
 

1. Family name:.........................................................................................................................................

2. First name(s):........................................................................................................................................
 

3. Status: individual, group, non-governmental organization, inter-governmental agency, Government. Please specify:

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4. Address (telephone, fax, e-mail):

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5. Please state whether you want your identity to be kept confidential: ...............................................................
 
 
 

Date:
 

Signature of author:

 

 
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