Arrest and Detention Report – Refugee Malaysia

Have you reported this before?*

REMINDER:
Please do not submit the same report more than once as it will cause further delays in processing. Thank you for your patience.

Details of Person Arrested/Detained

Full name*

Is the person registered with UNHCR?*

UNHCR case number*
The one WITH the letter C.

UNHCR individual number (optional)
The one WITHOUT the letter C.

UNHCR appointment card reference number*
NOT serial or security numbers.

Age*

Country of origin*

Ethnicity

Others*
Kindly provide ethnicity for others.

Religion

Others*
Kindly provide religion for others.

Vulnerability
Health or disability
Minor, elderly or pregnant
Single Parent or sole breadwinner
Others

Others*
Kindly provide vulnerability for others.

Details of Arrest/Detention

Date of Arrest*

Date of arrest*
If you are not sure, select the closest to when do you think it happened.

Place of arrest*

Reason(s) for arrest*
Immigration
Criminal
Others

Others*
Kindly provide reason for arrest for others.

Provide further information for reason(s) for arrest

Detention location*

Police lock-up (Station, district HQ or contingent)*
Kindly provide detention location for police lock-up.

Which immigration detention centre?*

Which prison?*

Which shelter or safe house?*

Others*
Kindly provide detention location for others.

Body number (optional)

Court date (optional)

Court location (optional)

Details of Arresting Officer

Full name

Phone number

Secondary phone number (optional)

Agency

Others
Kindly provide agency for others

Office location

Details of Person Reporting

Full name*

Phone number*

Secondary phone number (optional)

Email (optional)
Enter Email Confirm Email

Relationship to arrested person*

Others*
Kindly provide relationship to arrested person for others

Further information on this report (optional)

Further information on this report*

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