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III. State concerned/articles violated/domestic remedies
Name of the State party (country) to the International Covenant and the Optional Protocol against which the
communication is directed ..................................................... Articles of the International
Covenant on Civil and Political Rights allegedly violated:
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Steps taken by or on behalf of the alleged victim(s) to exhaust domestic remedies-recourse to the courts or other
public authorities, when and with what results (if possible, enclose copies of all relevant judicial or
administrative
decisions):
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If domestic remedies have not been exhausted, explain why: .........................................
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IV. Other international procedures
Has the same matter been submitted for examination under another procedure of international investigation or
settlement (e.g. the Inter-American Commission on Human Rights, the European Commission on Human Rights)? If so,
when and with what results?
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V. Facts of the claim
Detailed description of the facts of the alleged violation or violations (including relevant dates)*
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