This form is for victims who died as a result of the popular uprising in Syria, please answer all the questions. Questions with a ‘*’ are mandatory, so we are able to take steps to document and follow, which will allow more consideration of the case.

*Do you have an authorization by the victim’s family to directly submit the form on their behalf?
YesNo

*Will you be able to follow and transfer information between the family and SNHR team in case any further explanations were needed?
YesNo

Victim’s Information

*First Name:

*Last Name:

*Father’s Name:

Mother’s Full Name:

Birth Date:

Birth location:

*Gender:
MaleFemale

Job/Profession:

*Was the victim under 18 years of age when he died?
YesNo

Nationality:

Place of Residence:

Social State:
SingleMarriedWidowed

Information Regarding the Incident:

* Date of Incident:
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* Location:

Time:

* Party responsible for the murder, please explain why you think this party is the responsible one:

*Murder means (warplanes shelling, artillery shells, mine explosion, slaughter, drowning, torture, gunshots…):

*Circumstances of the Incident, please give all the details you know about the incident:

*If there were any witnesses to the incident, please give their names, relation to the victim. If they wish to keep their identity confidential please clarify, if they are relatives, pass-byers, or else. If there is an evidence, please point it out.

Has there been any action taken by the family or acquaintances after the violation was committed (reporting to official authority / informing Human Rights organizations) if not clarify why?

Did the official authority take any action (investigation, forensic…)

*Attach an image of the victim before and after the victim’s death or any related documents

Information about the Information Recorder:

*Name:

Relation to Victim:

*Communication Address:

Would you like to file a complaint to the United Nation’s Special Rapporteur about the incident?
YesNo

The information and its source are confidential and unavailable to share unless for the sake of documentation or in the service of any related human rights report