6. Identity of the person or organization submitting the report (*): (a) Family name: ..................................................................................... (b) First name:................…………........................................................... (c) Relationship to the disappeared person: ............................................ (d) Organization (if applicable):................................................................ (e) Address (telephone, fax, e-mail): ........................................................ ............................................................................................................... ............................................................................................................... (f) Please state whether you would like your identity to be kept confidential Yes, keep my identity confidential: _____ No request for confidentiality: _______ Additional information on the case Please indicate any other relevant information that has not been covered by the previous questions. If one of the mandatory elements noted (*) in this report could not be answered, please indicate why. ............................................................................................................... ............................................................................................................... Date:.................................. Signature of author: ................................... Address to submit cases: E-mail: wgeid@ohchr.org Fax: +41 22 917 9006, attn: Working Group on Enforced or Involuntary Disappearances Post: Working Group on Enforced or Involuntary Disappearances OHCHR, Palais des Nations 8-14 Avenue de la Paix CH-1211 Geneva 10 (Switzerland) 26