Refugee and Asylum Seeker Support Request

Notes:

Although not all sections of this form may apply to you, or you may not have all the required information available, please provide as many relevant and necessary details as possible.
Article 18 will make every effort to protect the information you provide.
The information submitted in this form will be stored in our database online for a short period and will then be securely transferred and encrypted in another location. Access to this data will be restricted and available only to a limited number of authorised Article 18 staff members.
Access to this information is limited to the Advocacy Manager and the organisation’s Data Protection Officer.
Required fields must be completed.

Assistance Request Form

"(Required)" indicates required fields

Comments

This field is for validation purposes and should be left unchanged.

Have you been a victim of human rights violations in Iran based on Article 18 of the Universal Declaration of Human Rights (freedom of religion or belief)?

Yes

Unfortunately, you do not meet the eligibility criteria to receive support from Article 18.

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Incident Report

Please select one or more options:

You were summoned for interrogation

You were arrested

You were detained for more than 24 hours

You received a court sentence

You were imprisoned

Reporter’s Details

Reporter’s Full Name(Required)

Name Surname

Reporter’s Phone Number(Required)

Reporter’s Email

Applicant’s Details

Applicant’s Full Name(Required)

Name Surname

Date of birth(Required)

Day

Month

Year

Marital Status(Required)

Spouse’s Name

Children’s Name

City(Required)

Immediate Family (Father, Mother, Sister, or Brother)

Name, age, and contact details

Summoned for interrogation

Summoned for interrogation(Required)

Date? Time? Phone call? Letter?

Which authority or government body was involved?(Required)

Please explain.

What was the interrogation about, and how long did it last?(Required)

Please explain.

Were you subjected to violence or ill-treatment during the interrogation?(Required)

Please explain.

Arrest

Where were you arrested?

Private residence

At a house church gathering

Workplace

Public place

Other

When did this incident occur?(Required)

Exact date? Time?

If an arrest took place, who carried it out?(Required)

Which individuals or authorities were involved? How many officers were involved? Were they armed? What equipment did they have? Please explain.

Were you shown a search warrant or arrest warrant?(Required)

Yes

What reason was given for your arrest? Were you able to see the arrest warrant?(Required)

Please explain.

Please describe exactly what happened to you.(Required)

Date of temporary release?

Detention

How many days were you in detention (including in solitary confinement)?(Required)

Date and place of detention?(Required)

Name of detention centres, including solitary confinement, suite, or general ward.

Date of formal charges?

This refers to the time when you were taken to the prosecutor’s office or appeared before a judicial authority, and the charges and reason for your arrest were clearly read to you.

Date of temporary release?(Required)

Was any bail or security measure issued? (e.g. guarantee, surety, bail, etc.)(Required)

If bail was set, please specify the amount.

What were the charges against you?(Required)

Please state them precisely and use the legal terms and wording as written in the court verdict or as communicated to you and your lawyer.

Was a court hearing held?(Required)

Yes

Legal / Current Status

Date of the first-instance court hearing?

Name of the judge?

Your case file number:

Was an appeal hearing held? Date? Name of the judge?(Required)

Your imprisonment status

Date of imprisonment(Required)

Name of the prison (city and province)

Ward name or number

Date of release

Impact of the incident on you

Please describe, as far as possible, the impact of the incident (summons, arrest, detention, interrogation, conviction, imprisonment, etc.) on your life or that of your family members.

Impact on your safety

Impact on your employment and income

Impact on your spiritual life and church activities

Impact on your physical health and condition

Impact on your mental and emotional well-being

Request for Assistance

How can we help you?(Required)

Referral to a legal advisor or lawyer

Financial support for medical treatment

Psychological counselling for trauma and emotional harm

Advocacy support (approaching international bodies to request or apply pressure for justice in your case)

Media reporting and support campaigns (including advocacy activities)

Others...

What other support do you need?

Please describe your current living situation:(Required)

What is your legal status?(Required)

Asylum seeker

Recognised as a refugee by the United Nations High Commissioner for Refugees (UNHCR)

Recognised as a refugee by the Turkish Directorate of Migration Management

Awaiting appeal decision

Awaiting resettlement to a third country

Date of asylum application:(Required)

Date of acceptance of asylum application (if applicable)

Any additional information not covered in the above form