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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
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 dependents 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:
Outcome:
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:
Did 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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