I. IDENTITY
Last Name ???? ???????? First Name ?????? sign Sex: Birthdate Nationality Male Femail
?????? ????? ???????? ???????
UAE
Identity document (if any) ?????? ?????? ??? ???? ??????? ?????? ?? ???????
Issued by: On exit: Number
???? ??????? ?????? ??????? ???? ???????
Profession and/or activity (if believed to be germane(predicate) to the look into/detention)
?????? ????????? ?????? ???? ??? ???? ???? ????????
Address of usual residence
?????? ????? ??????? ???????- ?????
Attention: A fall apart questionnaire must be completed for each case of supposed arbitrary arrest or detention. As far as possible, all details requested should be given. Nevertheless, failure to do so will not be necessarily outgrowth in the inadmissibility of the communication.
II. Arrest
Date of arrest ?????? ???????? Place of arrest (as elaborate as possible)
????? ??????? - ?????? ????? ??????? ?? ?????????
Forces who carried out the arrest or are believed to puzzle carried it out
?????? ?? ?????? ?????? ???? ???? ?????????
Did they show a ensure or other last by a public authority?
Authority who issued the warrant or decision:
?????? ??????? ????? ?????? ??? ????????
Yes
No
Relevant legislation applied (if known)
???????? ???? ???? ???? ????????
III. Detention
Date of detention
?????? ????????
Duration of detention ???? ???????? Forces holding the detainee under custody
??????? ?????? ???? ???? ?????????
regimen that ordered the detention: ??????? ?????? ???? ???? ????????? Interior Ministry Reasons for the detention imputed by ?????? ???????? the governing Relevant legislation applied (if known)
???????? ?????? ????????
Describe the circumstances of the arrest and/or the detention and indicate precise reasons why you make the arrest or detention to the arbitrary
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