Crime Reporting Form

1
Who Are You?* This field is required.Please indicate your relationship to the incident
Victim
Family member or relative
Witness
Knowledgeable
Legal representative (proof required)
Other
2
Full Name* This field is required.نام کامل
First Name
Last Name
3
Pseudonym (if applicable)در صورتی که نمی‌خواهید نام اصلی تان را ذکر کنید، نام مستعار تان را استفاده کنید
First Name
Last Name
4
Date of Birth* This field is required.تاریخ تولد
Date
Month
Day
Year
5
Gender* This field is required.جنسیت
Please Select
Please Select
Male
Female
Transgender/Non-binary
Other/Prefer not to say
6
Nationality* This field is required.ملیت
Please Select
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Congo-Brazzaville)
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (fmr. "Swaziland")
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (formerly Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine State
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
7
Address* This field is required.آدرس
City
Street Address Line 2
District
Province
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Phone Number* This field is required.شماره موبایل
Country Code
Phone Number
9
Email* This field is required.ایمیل
example@example.com
10
WhatsApp* This field is required.شماره واتساپ
Country Code
Phone Number
11
Signalشماره سگنال خود را وارد کنید. در صورتی که از پیام‌رسان سگنال استفاده نمی‌کنید، اینجا را خالی بگذارید
Country Code
Phone Number
12
Proof of Your Identity* This field is required.Please upload proof of your/reporter's identity (Identity card, Passport, Power of Attorney, Other): لطفاً یکی از اسناد اثبات‌کننده هویت خویش (گزارش‌دهنده) را بارگذاری کنید
Identity card (Tazkera)
Passport
Power of Attorney
Other
13
Please upload proof of your (reporter's identity)* This field is required.لطفاً سند انتخاب شده در سوال قبلی را برای تأیید هویت خویش (گزارش‌دهنده)، ارایه کنید
Drag and drop files here
Select files to upload
Min. file size10.0KB, Max. file size: 4.9MB
Please upload one of the selected proofs in PDF, DOC, DOCX, JPG, JPEG, PNG, or GIF format, with a file size no larger than 5 MB
Cancelof
14
Full Name* This field is required.نام کامل
First Name
Last Name
15
Gender* This field is required.جنسیت
Please Select
Please Select
Male
Female
Transgender
Other/Prefer not to say
16
Date of Birth* This field is required.تاریخ تولید
Date
Month
Day
Year
17
Religion* This field is required.Please select the victim's religion. مذهب قربانی
Please Select
Please Select
Islam (Sunni)
Islam (Shia)
Hindu
Christian
Jewish
Atheist
18
Ethnicity * This field is required.Please select the victim's ethnicity. قومیت قربانی
Please Select
Please Select
Pashtun
Tajik
Uzbek
Turkmen
Imaq
Baloch
Nuristani
Arab
Sadat
Peshayi
Kyrgyz
Qazalbash
Gujar
Brahui
19
Citizenship* This field is required.Please select the victim's citizenship. شهروندی/تابعیت قربانی
Please Select
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Congo-Brazzaville)
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (fmr. "Swaziland")
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (formerly Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine State
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
20
Nationality* This field is required.Please select the victim's nationality. ملیت قربانی
Please Select
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Congo-Brazzaville)
Costa Rica
Croatia
Cuba
Cyprus
Czechia (Czech Republic)
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (fmr. "Swaziland")
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (formerly Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine State
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
21
Address* This field is required.Enter the victim's address. آدرس قربانی
Street Address
Street Address Line 2
City & District
Province
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
22
Phone Number* This field is required.Enter the victim's phone number. If unavailable, please provide a family member's phone number. شماره موبایل قربانی را وارد کنید. در صورتی که قربانی در دسترس نیست، شماره اقارب درجه یک آن را وارد کنید
Country Code
Phone Number
23
Email* This field is required.Enter the victim's email address. If unavailable, please provide a family member's email address. ایمیل آدرس قربانی را وارد کنید. در صورتی که قربانی به هر دلیل به ایمیل دسترسی ندارد، ایمیل اقارب درجه یک قربانی را وارد کنید
example@example.com
24
WhatsApp* This field is required.Enter the victim's WhatsApp number. If unavailable, please provide a family member's WhatsApp number. واتساپ قربانی را وارد کنید. در صورتی که قربانی به هر دلیلی شماره واتساپ ندارد، واتساپ اقارب درجه یک قربانی را وارد کنید
Country Code
Phone Number
25
Signal* This field is required.Enter the victim's Signal number. If unavailable, please provide a family member's Signal number. شماره سگنال قربانی را وارد کنید. در صورتی که قربانی از سگنال استفاده نمی‌کند و یا به هر دلیلی به سگنال دسترسی ندارد، شماره سگنال اقارب درجه یک آن را وارد کنید
Country Code
Phone Number
26
Proof of Victim's Identity* This field is required.Please upload proof of the victim's identity (Identity card, Passport, Picture, Video, Other): لطفاً یکی از اسناد زیر که هویت قربانی را ثابت کند، بارگذاری کنید
Identity card (Tazkera)
Passport
Picture
Video
Other
27
Please upload proof of victim's identity* This field is required.لطفاً سند انتخاب شده برای اثبات هویت قربانی را بارگذاری کنید
Drag and drop files here
Select files to upload
Min. file size10.0KB, Max. file size: 9.8MB
Please upload the selected proofs in PDF, DOC, DOCX, JPG, JPEG, PNG, GIF, ZIP, WMA, MPG, MP4, FLV, MKV, MOV, or AVI format, with a file size no larger than 100 MB
Cancelof
28
Types of Crime* This field is required.Please carefully select the type of crime. For more information, refer to the international crimes defined in the Rome Statute نوعیت جرم. لطفاً در باره نوعیت جرم و انتخاب کتگوری مرتبط آن دقت کنید. برای آگاهی بیشتر کتگوری جرایم، اساسنامه رم را بخوانید
War Crimes: Willful killing, torture, hostage-taking, extensive destruction of property, intentionally attacking civilians, civilian objects, and utilizing prohibited weapons, conscripting children, employing methods causing superfluous injury, and committing sexual violence.
Crimes Against Humanity: Acts committed as part of a widespread or systematic attack against any civilian population, with knowledge of the attack, include murder, extermination, enslavement, deportation or forcible transfer of population, imprisonment, torture, sexual violence (including rape), persecution of identifiable groups, enforced disappearance, apartheid, forced pregnancy, and other inhumane acts causing suffering or injury.
Genocide: Acts committed with the intent to destroy, in whole or in part, a national, ethnic, racial, or religious group include killing members of the group, causing serious bodily or mental harm to them, deliberately inflicting conditions of life intended to bring about the group’s destruction, imposing measures to prevent births within the group, and forcibly transferring children to another group.
Human Rights Abuses: Denied or prevented from exercising their fundamental rights and freedoms, as recognized by international law. These include rights outlined in the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights (e.g., the right to life, freedom from torture, freedom of expression, and the right to a fair trial), and the International Covenant on Economic, Social, and Cultural Rights (e.g., the right to work, education, and health).
29
Date of Crime* This field is required.تاریخ جرم. اگر در باره وقت آن دقیق‌تر نمی‌دانید، می‌توانید تخمین بزنید
If the date and time is unknown, please estimate
Day
Month
Year
12
1
2
3
4
5
6
7
8
9
10
11
12
00
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
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42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
AM
PM
30
Location of Crime* This field is required.موقعیت یا ساحه جرم
31
Perpetrator(s) of the Crime* This field is required.عامل یا عاملان جرم. در صورتی که معلومات دقیق در موتر عامل جرم دارید، می‌توانید در بخش توضیح جرم آن را ذکر کنید
Taliban (Islamic Emirate of Afghanistan)
Haqqani Network
ISIS-Khorasan ( داعش خراسان)
Afghan National Army (Islamic Republic of Afghanistan)
Afghanistan Freedom Front
National Resistance Front of Afghanistan
Other
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Losses Caused by Crime (specify accuracy/estimation/unknown)* This field is required.تلفات و خسارات انسانی و مالی ناشی از جرم
Please specify any human or financial losses resulting from the crime, and indicate whether the figures provided are accurate, estimated, or unknown.
0/200
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Description of the Crime* This field is required.شرح بیشتر و دقیق‌تر جرم
Please describe the incident in as much detail as possible, including the nature of the crime, individuals involved, and any relevant context
0/800
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Evidence and Documentation* This field is required. اسناد مربوط به جرم. شامل عکس، ویدیو، صدا و هر آنچه که می‌تواند یک جرم را ثابت کند
Drag and drop files here
Select files to upload
Max. file size: 29.3MB
Please upload any documentation that can provide evidence or insight related to the crime, including any photos, videos, audio recordings, or sketches or drawings of the crime scene. It must be in doc, docs, pdf, mp3, wma, mpg, mp4, mov, mkv, flv, avi, jpg, jpeg, png, or gif format. No more than 50 MB.
Cancelof
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Have you shared this information with any other organization?* This field is required.آیا این معلومات را با کدام نهاد دیگر شریک کرده اید؟ اگر بلی، لطفاً در سوال بعدی در مورد این‌که به کدام نهاد شریک کرده اید و چه اجراآتی صورت گرفته است تا بتوانیم هماهنگی لازم را با آنها داشته باشیم
YESNO
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If yes, briefly describe who they are* This field is required.در صورت اشتراک این معلومات با کدام نهاد دیگر، لطفاً بگویید که به کدام نهاد شریک کرده اید
0/100
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How we contact you if needed?* This field is required.در صورت نیاز، چطور می‌توانیم به شما تماس بگیریم؟
Email
Phone
WhatsApp
Signal
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By submitting this form, you agree to the following terms and conditions:* This field is required.با ارسال این فرم، شما به شرایط زیر موافق هستید
Your information will be kept confidential and will only be shared with your consent, unless legally required. The details will be used solely for documentation, advocacy, and processing the reported crime.
The information provided is accurate to the best of your knowledge and has not been falsified.
You agree to provide additional information upon requestand, if necessary, provide or act as a witness. Your cooperation may berequested in legal proceedings or investigations related to reported crimes.
Submitting a crime report through this form does not guarantee legal action or prosecution. While we are committed to supporting you and your case, we cannot ensure a specific outcome or legal result.
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Data Privacy Policy* This field is required.
40
Submission Date of this Form* This field is required.تاریخ ارسال فرم
Date
Day
Month
Year
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Please verify that you are human* This field is required.
42
Unique ID
Should be Empty: