Annex I FORM TO SUBMIT A COMMUNICATION ON A VICTIM OF AN ENFORCED OR INVOLUNTARY DISAPPEARANCE Important: Elements indicated with an asterisk (*) are mandatory. Note: If any information contained in the report, besides the mandatory requested elements, should be kept confidential, please write “CONFIDENTIAL” beside the relevant entry. CASES SUBMITTED BY ORGANIZATIONS: Please note that if a case is being submitted to the Working Group by an organization, it is necessary for that organization to follow up on it by conveying Government information from the Working Group to the family and from the family to the Working Group until the fate or whereabouts of the person are determined. In this regard, please indicate whether the reported victim’s family has given its direct consent for your organization to submit this case to the Working Group on its behalf and whether your organization will be able to liaise between the family and the Working Group. * Consent of victim’s family given directly to your organization to submit this case? Yes, direct consent received from family _______ No consent from family _______ *If this case is being submitted by an organization, will the organization be able to follow up by conveying information between the family and the Working Group? Yes _____ No____ 1. Identity of the disappeared person: (a) Family name (*):.................................................................................. (b) First name (*): . .................................................................................. (c) Sex: male __ / female __ (d) Date of birth:...................................................................................... 23