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Human Rights

Enforced Disappearances, Arbitrary Executions and Cremations:
Victim Testimony and India's Human Rights Obligations
Interim Report

APPENDIX F:
The Committee for Coordination on Disappearances in Punjab
Chandigarh Secretariat: 742, Sector 8, Chandigarh. Tel. 544920
New Delhi Secretariat: 56 Todarmal road, (Bengali Market) N Delhi. Tel. 3714531

A Design for Incident Report Form

Name of the disappeared/ dead person:

Caste:

Father's name:

Mother's name:

Address:

...............................................................................................................(top sheet : to tear along the dotted line)

Name of the disappeared/ dead person:

Alias, if any:

Caste:

Father's name:

Mother's name:

Address:

Alias if any:

Age (Give date of birth if possible):

Educational qualification:

Profession/ occupation:

Monthly earning:

Other sources of income:

Marital status:

Name of the spouse and the address:

Age:

Employed/ unemployed/ details:

Spouse's parents:

Father's name and age:

Mother's name and age:

Profession/occupation:

Residence:

Children:

Names/age/sex:

Names of other dependants within the joint family:

General background of the disappeared/ dead person:
(Specially relevant would be details of hostile interaction with the security forces since 1984.)

Date and time of disappearance:

Location of disappearance:
(Include as much detail as possible)

Circumstances of disappearance:
(Short narrative statement with names of people responsible)

Are there witnesses? Yes/No.

Details of witnesses: Names/ addresses:
(Note: Specify if you do not wish to divulge the names of witnesses for the present. In which case do not fill this column.)

Perpetrator/s:

Name/s:

Age/ Physical description:

The security agency to which the perpetrator/s belong:

Rank

Uniformed or in plainclothes?

Description of uniform/dress:

Attached to which police station when the incident happened?

The present posting:

Any other details which you might want to add:

When was the person last seen?

By whom?

Where?

Steps taken to trace the "disappeared" and the results:

First Information Report filed? Yes/No

If yes, the number and the date:

The name of the police station:

Name of the officer who recorded the report:

Outcome, if any:

Habeas Corpus Petition filed? Yes/No

If yes, the number, date, and the court:

Name of the lawyer:

Address:

Telephone No.

Outcome:

Appeals made to local and national authorities. Give details. Photocopies if possible:

Ourcome:

Is it possible that the disappeared person may be alive? Yes/ No

Give reasons why you believe this:

If believed to be alive, name the location where the person might be found:

Is it assumed that the person has been killed and cremated? Yes/ No

If yes, why you believe this:

Is it assumed that the dead-body was disposed of in any other manner? Yes/ No

If yes, explain why you believe this:

Was the incident reported in newspapers? Yes/No

If yes, name the newspaper/s:

Date/s on which the report appeared:

Was there ever any report in the press about the disappeared/ dead prior to this incident? Yes/ No

Give details:

Enclose copies if possible.


Have you had any official or unofficial communications with police officials concerning the fate of the person at any time? Yes/No

If yes, give details:


Has any other person known to you has also "disappeared"/ abducted/ reported killed in armed encounter in connection with the reported incident? Yes/No

If yes, give details:

Do you know of the "disappearance" of any other person?

Has any other member/s of your family "disappeared"? Yes/No

If yes, give details:

you receive the dead body for performing the last rites? Yes/ No.

If yes, from whom?

Was any property (structures, possessions, live stock or other chattel) damaged/ destroyed/ stolen/ expropriated in the course of the incident or subsequently? Yes/ No

If yes, give details:

Who owned the property which was damaged/ destroyed/ stolen/ expropriated?

Who damaged/ destroyed/ stole/ expropriated?

Names:

Agency to which they belong:

Rank-designation:

Description for identification:
Age:

Physical description:


Describe the property:

1. Damaged: Value:

2. Destroyed: Value:

3. Stolen: Value:

4. Expropriated: Value:

Has the event of "disappearance" had any psychological/medical consequences in the family? Yes/No:

If yes, give details:
Hospitalization/ Expenses:

Has there been any death in the family connected/ subsequent to the event of "disappearance"? Yes/No:

If yes, give details:

Other comments:

Signature of the person giving details of the incident:

Name in full:

Father's name:

Mother's name:

Relationship to the missing/ killed/ cremated person:

Present Address:

Date/Place


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