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My personal data
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Section describing the facts of which you were a victim or witness
Have you been a victim or a witness? Click on the choice that corresponds to your situation
You have been the victim or witness of an anti-Semitic act. It is either a report for a slippage on the media or social networks, or an attack on the person.
Enter the date of the facts of which you were a victim or witness
DD slash MM slash YYYY
Do you know the exact time of the events? If yes, tick yes otherwise tick no
Enter the time of the facts
Choose the type of facts you denounce
Location of the Facts
Enter here, if you consider it necessary, additional information on the place of the facts, for example: staircase, elevator .....
You are requested to fill in this section precisely. This is essential for your complaint to be taken into account. Describe the nature of the verbal or physical insults, assaults or violence you experienced or witnessed
Your report concerns a human rights violation
Violation of human rights: insult, defamation, physical aggression, moral harassment, murder, theft...
Report of the authors:
Description of the authors, give all the details you remember even those that seem unimportant to you
Indicate the number of people who contributed to this crime
Give the approximate height of the perpetrators
If you noticed the authors' attire, give details here
Enter here any other information that you think is useful to describe the perpetrators: morphology, supposed origin,...
Your report concerns the Media, Internet or Social Networks
Media, Internet or Social Media Statement
You can choose one or more choices. To choose several choices click while pressing the Control key (Ctrl)
Select media type
Specify the name of the show, the channel, the newspaper, the link to the page of the site, Facebook, Twitter, Youtube etc...
If you know it, specify the name of the presenter, the journalist, etc,... Otherwise leave blank
Enter the following additional information here:
Have you filed a complaint with an authority?
If you have filed a complaint, can you report to whom?
Select the organization that examined you following the facts.
If so, indicate the number of ITT days that the doctor has prescribed for you
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