N AT I O N A L I N Q U I R Y R E P O R T ZIMBABWE HUMAN RIGHTS COMMISSION For Human Dignity Annexure 4: Sample Witness Submission Form Biodata Date / / / First Name…………………….Middle Name…………………….Surname………………... Other Names………………. Sex…………. Date of birth / / Nationality……………….. / Identity Number………………………… Marital Status……………………………….. Physical Address…………….............................................................................................. Postal Address…………………………………………………………………………………… Alternative Address……………………………………………………………………………… Ward………………District…………………..City………............. Province…………………. Phone Number……………………… Next of Kin and contact details……………………………………………………………………………………………. Disability Yes No If Yes, specify……………………………………………………... Do you know about the ZHRC? Yes No How did you know about ZHRC? Radio Other TV Press From a friend Social Media Please Specify: ____________________________ Have you ever reported a case to the ZHRC? YES NO Are you submitting the form on behalf of someone (if yes state, who and why?) Which document(s) are you facing challenges in accessing? (Tick Birth certificate Passport Death Certificate in relevant boxes) National Identity Document Citizenship Certificate What are the challenges you are facing in accessing the document(s) you stated above? What steps have you taken in addressing the challenges mentioned above? How has lack of the above-mentioned document (s) affected you? Are there other people who have been affected by your lack of the above-mentioned document (s)? If yes specify How do you think the challenges can best be resolved (Recommendations)? I……………………..................do hereby accept the responsibility of maintaining confidentiality of all information received and shared during the course of the National Inquiry on Access to Documentation in Zimbabwe. Signed…………............Place……………………………. 80 80