Provisional Information Request Thank you for approaching REDRESS in relation to this case. REDRESS is a small human rights organisation based in London and The Hague. Where we can, we seek to help torture survivors obtain justice and reparation. Our mission is: i) to deliver justice and reparation for survivors of torture, ii) to challenge impunity for perpetrators, and iii) to advocate for legal and policy reforms to combat torture.Given our size we only take on a few new cases every year. Whilst investigating your case, we will be polite and considerate, keep your information confidential, and not discriminate against anyone. If REDRESS is able to take on this case, we will put your interests first when representing you, treat all our clients fairly and, make every effort to provide relevant and realistic advice. To help us consider whether or not we can take on your case, please answer as many questions as possible in the form below. Please do not worry if you are unable to fill in some of the questions, complete as many as you can.Once the form has been submitted, we will review the information as soon as we can and then let you know whether or not we can take on your case. This process can take several weeks.YOUR CONTACT INFORMATIONTitle and name* Enter your titleMx.Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Name Family Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home numberWork numberMobile numberFax numberEmail I am happy for REDRESS to contact me by:* Post Phone Email ADDITIONAL INFORMATIONDo you need an interpretation from English?YesNoWhich language do you need an interpretation for?*What is your gender?MaleFemaleUnspecifiedDate of birth Date Format: DD slash MM slash YYYY Place of birthNationality at birthEthnicityNationality(ties)Please indicate your current location.Including address where available.Date of arrival in current location Date Format: DD slash MM slash YYYY Please indicate your residential status.Citizen/ NationalRefugee (granted)Refugee (in progress)Asylum (granted)Asylum (in process)OtherPlease indicate your marital status and if you have children.STEPS ALREADY UNDERTAKEN (IF RELEVANT)Facts alleged: description of torture, when and where it occurred, by whom (names of authorities or individuals), and what happened. Brief details of any action already undertaken to seek justice, accountability and reparation in the State where the torture occurred.Brief details of any action(s) already undertaken to seek justice, accountability and reparation in your home State, if different from above.Brief details of any remedies, reparations, or awards already made, if applicable, in the State where the torture occurred.Brief details of any medical or psychological reports relating to torture obtained in/from the State where the torture occurred.Brief details of any other documentation of the torture available (photographs, witness statements or a list of people willing to provide statements; links to YouTube or other online videos; links to reports by NGOs or other bodies referring to the case).File Drop files here or Use of the informationOur use of the information you provide is subject to your instructions, the Data Protection Act 1998 and our duty of confidentiality. If we need to speak with and provide information to third parties (such as experts or other professional advisers) we will always put in place a confidentiality agreement with these individuals. If however, you do not want your case to be disclosed to individuals outside the organisation, please tell us in advance.*I am happy for REDRESS to speak with and provide information to third parties.I prefer my information not to be disclosed to third parties.