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Date of the incident:

Time:
nightday

Place of the incident:

Do you know the perpetrator?
YesNo

Are there any (other) witnesses?
YesNo

Did you report the incident to the police?
YesNo

If not, why not?

Did you turn to any other organisation or person?
YesNo

If yes, to whom?

Can you tell us more about the incident itself?

We would ask that you be as precise as possible in your description. Eg: How many perpetrators were there? Do you know them? Were you injured? Age? What were the consequences of the attack / discrimination?

If you have additional materials (videos, pictures, etc.) you can share them with us here.

I want help
Contact (phone number or e-mail):