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Report on-line here:

 

 

ABOUT THE INCIDENT

 

Are you the victim or a witness?

Victim Witness Third Party  

What do you think motivated this incident?

 

Tell us about the incident in your own words, giving as much detail as possible

 

When did the incident take place?

 

Where did it happen?

Street name/Location/Town/City

Were there any injuries?

if 'yes' please give details

Did any loss or damage to property result from the incident?

if 'yes' please give details
 

ABOUT THE OFFENDER(S)

 

Do you know them?

If ‘yes’ please give names and if possible addresses.

How many offenders were there?

 

Can you give a description?

Consider age, gender, height, ethnicity, build, clothing and marks.

Was a vehicle used?

Please describe the vehicle e.g. colour, make, model.
 

ABOUT THE VICTIM

 

Age

 

Date of Birth

 

Disabled

 

Gender

 

Gender Identity

 

Ethnicity

 

First language

 

Faith

 

Sexual Orientation

 
 

PERSONAL DETAILS

The details you have provided to us so far will be recorded for monitoring purposes.

If you wish this incident to be investigated please include how you would prefer to be contacted.

 

Your Name

 

Your Address

 

Postcode

 

Telephone number

 

E-mail

 

Please tell us how you would prefer to be contacted e.g. only at a certain time or location.

 
     

Do you agree to this information being passed to your local agency partnership?

Yes No  

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