Since the International Criminal Court is ignorant of the fact that most victims of gross crimes against humanity, do not have a desktop computer, with printer and colored ink to print the form for victims to fill out, and the page on the internet for victims to print is a PDF file, which most people in the Middle East cannot open due to censorship apparently, i have copied the document text and pasted it below for anyone who would like to file a complaint to International Criminal Court about human right violations. All the information you need has been copied below. I was not able to keep the format. Hopefully, the International Criminal Court will be more sincere about helping victims in the near future. God Bless you!
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Request for Participation in Proceedings and
Reparations at the ICC
For Individual Victims
PART A
PERSONAL INFORMATION
1. H
the
ICC?
as
the victim already submitted an application for participation or for
reparations to
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.
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