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Wednesday, November 16, 2016

Matthieu Ricard: How to let altruism be your guide

Individual #Victims May Request #ICC #Investigate #CrimesAgainstHumanity - Application FORM



*I can no longer find this form on the International Criminal Court's Website. I am not sure why, but I am happy that I saved a copy for you below:


Application Form
For Individuals
Request for Participation in Proceedings and Reparations at the ICC
(International Criminal Court)
For Individual Victims

 PART A
PERSONAL INFORMATION
 Has the victim already submitted an application for participation or for reparations to ICC?
Yes No
2. If yes and the victim has a registration number, please indicate it here:
/ /
3. Name(s) of the victim:
4. Sex:
5. Date of birth:
and / or Age
(day) (month) (year)
6. Place of birth:
(village/ town) (country)
Application Form
Request for Participation in Proceedings and Reparations at the ICC
For Individual Victims
Joint Participation/Reparation Form for Individuals
5. Where th e vic tim ’s date
of birth and age are
unknown, please give
approximate date or age
or provide any information
that will enable the age
to be identified.
Please give all names, as completely as possible
7. Number of dependants:
7. Indicate the number of
people such as children,
orphans or other family
members who are
dependant on the victim
for financial or other
support.
for Individuals
Part A. If any of the
information provided
here is different from
the information on your
identity documents,
please explain why next
to your answer.
Female Male
8. Tribe/ethnic group (optional):
9. Occupation (specify any work, duties): 9. Please indicate what
work the victim does, if
any, or whether the
victim is a student or
unemployed.
11. What proof of identity is the victim providing?
Please specify:
12. Where does the victim currently live?
Village/City/Town:
County/District/Province:
Country:
13. Is the victim applying on his/her own behalf?
Yes No
If yes, go to question 22.
11. It is a requirement that
the victim provide proof of
identity. This can include,
for example, national
identity card, birth
certificate, voting card,
passport, driver’s licence,
student or employee card,
letter from a local authority,
camp registration card,
card from a humanitarian
agency, tax document or
other document identifying
the victim.
13.Usually a victim will
apply for him/herself.
In some cases this is not
possible, for example
because the victim is a
child or is disabled,
deceased or disappeared.
In such cases, another
person may be permitted
to act on behalf of the
victim. The victim should
consent to have another
person act on his/her
behalf if the victim is able
to. If somebody is acting
on behalf of the victim,
Joint Participation/Reparation Form for Individuals, version 1, draft
page 2 of 7
then answer ‘no’ to
question 13 and complete
questions 14 to 21.
Joint Participation/Reparation Form for Individuals
10. What language(s) does the victim speak?
14. If no, what is the name of the person acting on behalf of the victim?
Please give all names, as completely as poss ible
15. Why is this person acting on behalf of the victim?
a. The victim is a child under 18 years of age
b. The victim is unable to act for him or herself because of disability
d. Any other reason?
16. What is the relationship between the victim and the person acting on behalf of the victim?
Proof of this relationship must be attached
16. Where answer a , b o r
d has been ticked in
q
be
uestion 15, proof must
provide d of t he
relationship between the
victim and the person
acting on behalf of the
victim. See note 11 for
c. The victim is an adult and gives his or her consent
Please specify as completely as possible
Please tick only one box
examples of documents
that might prove the
relationship. If c is ticked,
the victim must give
his/her consent by signing
at the end of this form.
17. Sex of the person acting on behalf of the victim:
Female Male
18. Date of birth of the person acting on behalf of the victim:
and/or Age
(day) (month) (year)
19. What language(s) does the person acting on behalf of the victim speak?
20. What proof of identity is the person acting on behalf of the victim providing?
Please specify: 20. See note to question 11.
Joint Participation/Reparation Form for Individuals, version 1, draft
page 3 of 7
Joint Participation/Reparation Form for Individuals
21. Did the person acting on behalf of the victim also suffer harm as a result of the crimes?
Yes No
If yes, the person acting on behalf may complete his or her own standard application form.
22. How can the victim or the person acting on behalf of the victim be contacted?
Contac t person / organisation:
Street: Number/Plot:
P.O. Box: Sector/Cell/Zone:
Village/City/Town/Camp:
Sub-county/Parish:
County/District/Province:
Postal Code: Country:
Email:
Please fill in as much information as possible
23. Is somebody assisting the victim to fill in this form?
Yes No
22. This could be the
victim’s own address or
the address of an
organisation, a family
member or other
individual, if the victim
prefers to be contacted
through someone else.
Telephone Number( s):
24. If yes, what is that person's name and organisation (if any)?
(name) (organisation)
25. Is an interpreter assisting with the filling in of this form? Yes No
PART B
INFORMATION ABOUT THE ALLEGED CRIME(S)
26. What happened to the victim? Describe the event(s) in as much detail as possible.
If more space is needed, please attach answers to this question on a separate s.heet of paper
Joint Participation/Reparation Form for Individuals
page 4 of 7
27. When did the event(s) occur ?
If possible, please specify day(s), month(s) and year(s), or where the exact dates are not known
please provide any information that will enable us to identify the dates
28. Where did the event(s) take place?
If necessary, attach a drawing or a map of the location
29. Who does the victim believe is responsible for the event(s )? If possible , explain why
28. Please be as specific
as possible, and also, if
possible, please refer to
the district/province
or the nearest town/city.
the victim believes this.
PART D
PARTICIPATION IN THE PROCEEDINGS
31. Does the victim want to present his/her views and concerns in ICC proceedings?
PART E
REPARATIONS
33. Would the victim like to apply for reparations?
i.e does the victim want something to be done for what he / she suffered?
Yes No
34. If yes, what would the victim want?
32. If yes, why does the victim want to participate in the proceedings?
Yes No
33/34. What is the victim
expecting if the accused
person is found guilty?
Reparations can be
anything which can
help the victim to repair
the harm suffered. This
can include compensation,
various forms of
assistance, receiving back
lost land or property,
and / or symboli c or
moral mea sures su ch as
apologies and monuments.
Please list any measures
which the victim
would like.
Joint Participation/Reparation Form for Individuals
page 5 of 7
31. Usually a victim
presents his/her views and
concerns through a lawyer
who represents the victim
in The Hague. In a small
number of cases there may
be an opportunity for a
victim to be involved in
person, but this is not a
requirement.
PART C
INFORMATION ABOUT THE INJURY, LOSS OR HARM SUFFERED
30. What effect did the events have on the life of the victim and others around him/her?
Describe physical or mental injury, emotional suffering, harm to reputation, economic loss and / or
damage to property or any other kind of harm
30. If the victim has
documents demonstrating
the harm he/she suffered,
copies of these can be
attached. This includes,
for example, medical
records or proof of
economic loss or damage
to property.
Email: Telephone number(s):
PART G
COMMUNICATION OF IDENTITY
40. Would the victim have any reason to be concerned about his or her security, well-being, dignity
or privacy or that of any other person if his or her identity were to be revealed to the
defence or the ICC Prosecutor?
If yes, what are the reasons?
Yes No
40. The victim may have
concerns not only about
physical danger but also
about harm to his or her
psychological well-being,
r eputation, privacy
and/or dignity or those of
his or her family.
The identity of the victim
will not be revealed to the
public while the
application is being
considered. If the
application is accepted,
the victim may be asked
again about disclosure of
information.
Joint Participation/Reparation Form for Individuals
Please note that the present application will be given to the defence (the accused person and
his/her lawyers) and to the ICC Prosecutor. When this happens, the Judges may decide not
to reveal the identity of the victim.
page 6 of 7
37. If yes, please provide the lawyer’s contact details:
Name:
Address:
PART F
LEGAL REPRESENTATION
36. Does the victim have a lawyer?
38. If the victim does not have a lawyer, would the victim like assistance from the ICC to
find a lawyer?
39. Until the victim has a lawyer, would he/she like to be represented by the
Court’s lawyers for victims (the Office of Public Counsel for Victims)?
Yes No
Yes No
Yes No
36. In order to represent
victims before the ICC,
a lawyer must be on the
ICC list of counsel.
Lawyers who are not on
the list may apply for
inclusion.
39. The OPC V is an
independent office
within the Court
which looks after the
l
and which represents
victims free of charge.
egal interests of victims
35. If rep arations are ordered, who does the victim want the benefit to go to?
The victim
The victim's family
The victim's community (please specify the community)
Other:
Tick more than one box, if necessary
SIGNATURE OF THE PERSON ACTING ON BEHALF OF THE VICTIM
I hereby declare that:
• To the best of my knowledge and belief, the information contained in this Application
Form is correct
Signature, thumbprint or other mark of th e person acting on behalf of the victim
Date: Location:
(day) (month) (year)
R EM IN D ER :
If the victim is acting on
his/her own behalf and
has answered “yes” to
question 13 then there is
no need to fill in this part.
Joint Participation/Reparation Form for Individuals
page 7 of 7
PART H
SIGNATURES
SIGNATURE OF THE VICTIM
I hereby declare that:
• To the best of my knowledge and belief, the information I have given in the present
Application Form is correct

Signature, thumbprint or other mark of the victim
Date: Location:
(day) (month) (year)
If I have named someone to act on my behalf in question 14 of this form, I hereby give my
consent to that person to act on my behalf
THE FOLLOWING DOCUMENTS SHOULD BE ATTACHED TO THIS APPLICATION FORM
For the victim:
Photocopy of proof of identity (REQUIRED)
Photocopy of medical records or similar documents
For the person acting on behalf of the victim (if applicable)
Photocopy of proof of identity (REQUIRED)
Photocopy of proof of relationship to victim (REQUIRED unless the victim is an adult
who has given consent)
NOTE:
This Application Form and the process
of applying are free of charge.
The ICC does not charge any free at
any stage of the application process.