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submission.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Universal Period Review | United Nations</title>
<meta name="description" content="Cardio is a free one page template made exclusively for Codrops by Luka Cvetinovic" />
<meta name="keywords" content="html template, css, free, one page, gym, fitness, web design" />
<meta name="author" content="Luka Cvetinovic for Codrops" />
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<section class="section section-padded" style="background-image:url('img/header.jpg');">
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<div class="row"><center>
<h3 class="white typed">Submit a New UPR Complaint</h3><br />
<div style="border:1px solid white; padding:30px 60px; width:75%; background-image:url('img/footer.jpg');">
<div class="owl-twitter owl-carousel">
<div class="item text-left">
<div><h4 class="white heading small-heading no-margin regular"><span style="margin-left:6px;">PART I: Information Regarding the Victim</span></h4><br />
<div class="bigbox">
<p>Full Name:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Gender:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Date of Birth:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Country of Citizenship:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Occupation:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Ethnic, Religious, Social Beliefs (if relevant):<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
</div>
<div class="bigbox">
<p>Address:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Other relevant information:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Have the victim(s) given you his/her consent to send this communication on his/her behalf?:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Has the victim(s) been informed that, if the Special Rapporteur decides to take action on her letter concerning what happened to he:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Is the victim(s) aware that, if this communication is taken up, a summary of what happened appear in a public report of the Special:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Would the victim(s) prefer that her full name or merely his/her initials appear in the public report of Special Procedures of the Huma<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
</div>
</div>
<div class="bigbox">
<hr style="1px solid white">
<div><h4 class="white heading small-heading no-margin regular"> PART II: Information Regarding Incident</h4><br />
<p>Detailed Description of the Human Rights Violation:<br />
<textarea id="txtArea" rows="10" cols="60" style="border:3px solid #00a8ff;"> </textarea></p>
</div>
<div class="bigbox">
<p>Date:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Time:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Location / Country:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>What Number of Assailants were there?:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Are the assailant(s) known or related to the victim? If so, how?:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Name of nickname of assailant(s):<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Does the victim believe he/she was targeted specifically because of her identity, classified by gender, race, religion, or other subgr:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Has the incident been reported to the relevant state/national authorities? If so, which authorities and when?:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Have the authorities taken any action after the incident? If so, which authorities, what action, when?:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>If the violation was committed by private individuals or groups (rather than government officials), include any information which mig:<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
<p>Has the victim seen a doctor after the incident took place? Are there any medical certificates/notes relating to the incident concern<br />
<input class="form-control form-white" style="border:3px solid #00a8ff; height:20px;" type="text"/></p>
</div>
</div>
<div class="bigbox">
<hr style="1px solid white">
<div><h4 class="white heading small-heading no-margin regular"> PART III: Laws or Policies</h4><br />
<p>If your submission concerns a law or policy, please summarize it and the effects of its implementation on human rights. Provide co<br />
<textarea id="txtArea" rows="10" cols="60" style="border:3px solid #00a8ff;"> </textarea></p>
</div>
</div>
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