Submit a Case

Complete
Case Intake Form

A. Basic Information

Date of Submission*

Referred by*

Country Concerned*

Preferred language of communicate*

B. Applicant / Victim Information

Full Name(s)*

Date(s) of Birth / Age(s)*

Gender*

Nationality (if any)

Current Legal Status (citizen, refugee, stateless etc.)*

Residential Address*

Telephone/Whatsapp*

Email*

Preferred mode of communication*

Are you represented by a lawyer or organisation?*

C. Description of the case

Provide a detailed description of the facts (what happened, when, where, by whom)*

Which rights do you believe were violated?*

Who is responsible for the violation (State authority, private actor, etc.)?*

Is the violation ongoing?*

D. Victims and affected groups

Number of victims*

Are victims part of a marginalised or vulnerable group? If yes, specify:*

Community or group impacted (if applicable):*

E. Domestic remedies

Have you taken steps to seek justice at the national level?*

Courts, tribunals or authorities approached*

Dates and outcomes of proceedings*

If not pursued, explain why?*

F. Other remedial measures

Has the case/violation has been submitted to any other international or regional organisation for resolution through a formal complaint?

G. Evidence available

Documents available*

Witnesses willing to testify*

Other supporting materials:*

H. Safety, confidentiality and risks

Are there security risks to you or others if this case is pursued?*

Do you request confidentiality or anonymity?*

Any immediate protection needs?*

I. Strategic and impact considerations

Does the case involve a law, policy or widespread practice?*

Could this case affect others beyond the applicant(s)?*

Any related advocacy, media or community action underway?*

J. Partnerships and consent

Local organisations involved or recommended*

Do you consent to IHRDA working with partners on this case?

K. Declaration and consent

I confirm that the information provided is true to the best of my knowledge.*

I confirm that the information provided is true to the best of my knowledge.

Download Case Intake Form

Download

If you cannot submit the form electronically, download the form.

Send the form to:

Institute for Human Rights and Development in Africa (IHRDA)

949 Brusubi Layout, AU Summit Highway,
P.O. Box 1896 Banjul, The Gambia.

ihrda@ihrda.org

Defend, Educate, Inform

Get Involved

Subscribe to our Newsletter

Address:

Institute for Human Rights and Development in Africa (IHRDA)
949 Brusubi Layout, AU Summit Highway,
P.O. Box 1896 Banjul, The Gambia.

Contact us:

Tel: +220 44 10 413/4
Cell: +220 77 51 200
Email: ihrda@ihrda.org

Diversity, Inclusion and Safeguarding Statement