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{\title Hate Crime Incident Form}{\author atailor}{\operator Louisa Jordan}{\creatim\yr2007\mo3\dy29\hr13\min57}{\revtim\yr2007\mo8\dy15\hr14\min9}{\printim\yr2006\mo11\dy2\hr10\min48}{\version3}{\edmins2}{\nofpages7}{\nofwords1077}{\nofchars6144}
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\f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\b\ul\insrsid733181\charrsid11668793 Hate Incident }{\b\ul\insrsid14891225 Monitoring Form }{\b\ul\insrsid10362250  }{\b\ul\insrsid1666260\charrsid11668793  
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\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1580891 {\insrsid16463465 Working in partnership, }{\insrsid1580891 Leicestershire County Council is committed to}{\insrsid8992422 
 creating an inclusive county and believes that everyone who lives or works in or visits Leicestershire has the right to be treated with dignity and respect and to live without fear of hatred.  }{\insrsid1580891\charrsid14031552 
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\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1974991 {\insrsid5007611 No one should }{\insrsid1580891\charrsid14031552 have to tolerate hate incidents}{\insrsid1580891 ,}{
\insrsid1580891\charrsid14031552  reporting makes a difference, if we don\rquote t know about it we can\rquote t change it.  }{\insrsid16336901 
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ou or someone else has been targeted because they or you are believed to be different}{\i\insrsid8455461 ,}{\i\insrsid16336901\charrsid14031552  or any incident you believe was motivated by:  }{\i\cf1\insrsid16479912\charrsid5120330 
age, disability, gender identity, rac}{\i\cf1\insrsid16336901\charrsid5120330 e, religion}{\i\cf1\insrsid16479912\charrsid5120330  / belief}{\i\cf1\insrsid9464594\charrsid5120330  or}{\i\cf1\insrsid15821971\charrsid5120330  sexual orientation}{
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\insrsid4401917 All appropriate sections of the form need to be completed if you are }{\insrsid6170593 not the victim}{\insrsid4401917  
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\par {\listtext\pard\plain\f3\lang2057\langfe2057\langfenp2057\insrsid4401917 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ql \fi-360\li720\ri0\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid4401917 {
\insrsid4401917 Ignore section }{\insrsid9637463 5}{\insrsid4401917  if you are }{\insrsid9573492 the }{\insrsid4401917 victim 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9573492 {\insrsid9573492 
\par }{\insrsid1134556\charrsid4401917 Do}{\insrsid14572050 n\rquote t }{\insrsid1134556\charrsid4401917 worr}{\insrsid1134556 y }{\insrsid6187712\charrsid4401917 if you are unable to complete all sections, complete as much as possible}{\insrsid1134556 . P}{
\insrsid10097664\charrsid4401917 lease refer to }{\insrsid9264257\charrsid4401917 S}{\insrsid10097664\charrsid4401917 ection }{\insrsid9637463 7}{\insrsid10097664\charrsid4401917  for Data Protection Guidance. }{\insrsid1666260\charrsid4401917 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid1193651 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1193651 {\insrsid13202429 If you require the information in an alternative version }{\insrsid8267374 such as }{\insrsid13202429 
large print, Braille or tape }{\insrsid8267374 or help in understanding it in your language, }{\insrsid13202429 please call }{\insrsid1193651 0116 }{\insrsid3042810 30}{\insrsid1193651 5 8263, Fax: 0116 }{\insrsid3042810 30}{\insrsid1193651 
5 7271 or Minicom: 0116 }{\insrsid3042810 30}{\insrsid1193651 5 6048.   
\par 
\par }{\insrsid5007611 Please r}{\insrsid1193651 eturn completed forms to: the Project Co-ordinator (Hate Incident Monitoring), Leicestershire County Council, County Hall, Glenfield, Leicester LE3 8R}{\insrsid4926833 A}{\insrsid1193651 .    
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid1193651 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\b\ul\insrsid7764400\charrsid2652422 Section }{\b\ul\insrsid9637463 1}{\b\ul\insrsid7764400\charrsid2652422 : Incident Details 
\par }{\insrsid7764400 
\par 1.\tab Where did the Incident Happen? 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid7764400 \tab }{\insrsid4091981 In}{\insrsid8992422  }{\insrsid4091981 /}{\insrsid8992422  }{\insrsid4091981 Near victim\rquote s home

\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Leisure Facility
\par Public House}{\insrsid6510345  / }{\cf1\insrsid6510345\charrsid5120330 Pub / Bar}{\cf1\insrsid4091981\charrsid5120330 
\par }{\insrsid4091981 Public Transport
\par Restaurant}{\insrsid4091981\charrsid10124602  }{\insrsid4091981 
\par School 
\par School Transport
\par Shop
\par Taxi
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 \tab Workplace
\par \tab Other \tab \tab \tab Please specify 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 
\par }{\insrsid11820669 2.\tab Address of incident}{\insrsid11285859  }{\insrsid4091981 
\par 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3822664 {\insrsid3822664 3.\tab P}{\insrsid11285859 ost code }{\insrsid11820669 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid11820669 
\par }{\insrsid3822664 4}{\insrsid7764400 .\tab }{\insrsid8992422 W}{\insrsid7764400 hat type of incident }{\insrsid8992422 are you}{\insrsid7764400  reporting?
\par \tab Tick all that are appropriate
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Ageist
\par }{\cf1\insrsid4091981 D}{\cf1\insrsid4091981\charrsid4351468 isablist
\par }{\insrsid4091981 Homophobic
\par Racist
\par Religious belief
\par Sexist   
\par Transphobic
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 \tab Other \tab \tab \tab Please specify 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid4091981 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 
\par }{\insrsid6780649 5}{\insrsid7764400 .\tab What is the nature of the incident you are reporting?
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 Tick those that are appropriate 
\par 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Damage to property 
\par Intimidation
\par Offensive material 
\par Physical assault
\par Verbal abuse / threats
\par Other \tab \tab \tab Please specify }{\insrsid7764400 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 \tab 
\par }{\insrsid6780649 6}{\insrsid7764400\charrsid11431488 .\tab }{\insrsid7764400\charrsid6948939 Date}{\insrsid7764400  }{\insrsid12330445 of incident }{\insrsid7764400\charrsid6948939 
\par }{\insrsid7764400 
\par }{\insrsid6780649 7}{\insrsid3822664 .}{\insrsid7764400 \tab Time }{\insrsid12330445 of incident}{\insrsid7764400 
\par 
\par }{\insrsid6780649 8}{\insrsid7764400 .\tab Is this part of a series of incidents? \endash  Yes/No
\par 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid7764400 {\insrsid6780649 9}{\insrsid7764400 .\tab Has the incident been reported previously? \endash  Yes/No If so to which agency:
\par 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid4091981 {\insrsid7764400 \tab }{\insrsid4091981 District }{\insrsid8992422 / }{\insrsid4091981 Borough}{\insrsid8992422  Council}{
\insrsid4091981 
\par \tab Leicestershire County Council
\par \tab Police
\par \tab Other Agency \tab Please specify write box 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid7764400 {\insrsid6780649 10}{\insrsid7764400 .\tab Please describe the incident in detail below }{\insrsid7764400\charrsid5995338     
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\b\ul\insrsid7764400 
\par }{\b\ul\insrsid7764400\charrsid9463653 Section }{\b\ul\insrsid9637463 2}{\b\ul\insrsid7764400\charrsid9463653 : }{\b\ul\cf1\insrsid4471792\charrsid5120330 Alleged }{\b\ul\insrsid7764400\charrsid9463653 Perpetrator Details (if known)
\par }{\insrsid7764400 
\par }{\insrsid3822664 1}{\insrsid6780649 1}{\insrsid7764400 .\tab Name 
\par 
\par }{\insrsid11285859 1}{\insrsid6780649 2}{\insrsid7764400 .\tab Address
\par 
\par }{\insrsid14581479 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid7764400 {\insrsid6949844 1}{\insrsid6780649 3}{\insrsid7764400 .\tab Gender:
\par \tab }{\insrsid4091981 Female
\par }\pard \ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid4091981 {\insrsid7764400 Male
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid7764400 {\insrsid7764400 \tab 
\par }{\insrsid6949844 1}{\insrsid6780649 4}{\insrsid7764400 \tab }{\insrsid5007611 Is there anything else about the perpetrator that you are able to tell us?}{\insrsid7764400   
\par \tab 
\par }{\insrsid6949844 1}{\insrsid6780649 5}{\insrsid7764400 .\tab Ethnic Origin    
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 \tab }{\insrsid7686866 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid7686866 Asian or British Asian \endash  Bangladeshi
\par }{\insrsid7764400 Asian or British Asian \endash  Indian
\par }{\insrsid7686866 Asian or British Asian \endash  Other Asian
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 \tab Asian or British Asian \endash  Pakistani
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid7764400 \tab }{\insrsid7686866 Black or Black British \endash  African
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid7764400 Black or Black British \endash  Caribbean
\par }{\insrsid7686866 Chinese
\par Gypsies
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid15544979 {\insrsid15544979 Irish Travellers
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid7686866 Mixed \endash  Other mixed
\par Mixed \endash  White and Asian
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 \tab Mixed \endash  White and Black Caribbean
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 Mixed \endash  White and Black African
\par White \endash  British 
\par White \endash  Irish
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\insrsid7764400 \tab Not }{\insrsid6170593 specified / Unknown}{\insrsid7764400  \tab 
\par \tab Other \tab \tab \tab Please specify  
\par }{\insrsid15427852 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid9648605 {\insrsid6949844 1}{\insrsid6780649 6}{\insrsid7764400 .\tab }{\insrsid9648605 Details of other perpetrators involved in th}{
\insrsid8664052 is}{\insrsid9648605  incident   please specify }{\insrsid7764400  }{\insrsid7764400\charrsid19927 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\insrsid1974991\charrsid14031552 
\par }{\b\ul\insrsid11279022\charrsid11279022 Section }{\b\ul\insrsid9637463 3}{\b\ul\insrsid11279022\charrsid11279022 : }{\b\ul\insrsid1666260\charrsid11279022 Victim}{\b\ul\insrsid11279022\charrsid11279022  Details }{\b\ul\insrsid1589175 (Please see }{
\b\ul\insrsid12868719 S}{\b\ul\insrsid1589175 ection }{\b\ul\insrsid14090307 7}{\b\ul\insrsid1589175  for guidance)}{\b\ul\insrsid1666260\charrsid11279022 
\par }{\insrsid1666260 
\par }{\insrsid6949844 1}{\insrsid6780649 7}{\insrsid1769767 .\tab }{\insrsid1666260 Victim Name }{\insrsid7238022   }{\insrsid1666260 
\par 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11279022 {\insrsid6949844 1}{\insrsid6780649 8}{\insrsid1769767 .\tab }{\insrsid11279022 Address
\par }{\insrsid4531017 
\par }{\insrsid6949844 1}{\insrsid6780649 9}{\insrsid1769767 .\tab }{\insrsid11279022 Postcode
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid11279022 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11279022 {\insrsid6780649 20}{\insrsid1769767 .\tab }{\insrsid11279022 Contact telephone number
\par 
\par }{\insrsid3822664 2}{\insrsid6780649 1}{\insrsid1769767 .\tab }{\insrsid11279022 Contact E-mail
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid11279022 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16328811 {\insrsid11285859 2}{\insrsid6780649 2}{\insrsid1769767 .\tab }{\insrsid11279022 Gender}{\insrsid9979912  }{\insrsid477681 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid9506575 \tab }{\insrsid4091981 Female
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid9506575 Male}{\insrsid11279022 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid3147012 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid4531017 {\insrsid3147012 2}{\insrsid6780649 3}{\insrsid3147012 .\tab }{\insrsid13781738 Do}{\insrsid161434 es the victim }{\insrsid8605931 
live and work in the gender role }{\insrsid3147012 opposite to that assigned at birth \tab \tab }{\insrsid85689 Yes}{\insrsid161434  
\par \tab \tab \tab \tab \tab No}{\insrsid3147012  
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid8456231 {\insrsid85689 \tab \tab \tab \tab \tab Not specified /Unknown}{\insrsid9648605 
\par }{\insrsid14581479 
\par 
\par }{\insrsid6949844 2}{\insrsid6780649 4}{\insrsid8456231 .\tab Sexual Orientation}{\insrsid1653429 :  }{\insrsid8456231  }{\insrsid477681 
\par }\pard \ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid477681 {\insrsid15544979 Bisexual }{\insrsid477681 
\par }{\cf1\insrsid8456231\charrsid5120330 Gay}{\cf1\insrsid6510345\charrsid5120330  / Lesbian }{\cf1\insrsid477681\charrsid5120330 
\par }{\insrsid8456231 Heterosexual  
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid6510345 {\insrsid15544979 \tab }{\insrsid85689 Not specified/Unknown 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid15544979 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid12868719 {\insrsid6949844 2}{\insrsid6780649 5}{\insrsid1769767 .\tab }{\insrsid1666260 Age}{\insrsid16653949  }{\insrsid11435182 Group}{
\insrsid14353495  }{\insrsid11435182 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid14353495 {\insrsid11435182 \tab }{\insrsid14353495 \tab }{\insrsid11666196 \tab 
\par }\trowd \irow0\irowband0\ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117
\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11666196\yts19 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 Under 11\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10161202\yts19 {\insrsid10161202 30-44\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 \trowd \irow0\irowband0\ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117\row }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11666196\yts19 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\insrsid10161202 11-15\cell }\pard \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10161202\yts19 {\insrsid10161202 45-64\cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 \trowd \irow1\irowband1\ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117
\row }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11666196\yts19 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 16-19\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10161202\yts19 {\insrsid10161202 65+\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 \trowd \irow2\irowband2\ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117\row }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11666196\yts19 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\insrsid10161202 20-24\cell }\pard \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10161202\yts19 {\insrsid6170593 Not }{\insrsid10161202 specified}{\insrsid6170593  / Unknown}{\insrsid10161202  \cell 
}\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 \trowd \irow3\irowband3\ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117
\row }\pard\plain \ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11666196\yts19 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 25-29\cell  \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\insrsid10161202 \trowd \irow4\irowband4\lastrow \ts19\trgaph108\trleft857\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind965\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx2987\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2130\clshdrawnil \cellx5117
\row }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid14353495 {\insrsid11435182  }{\insrsid14353495 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid932477 {\insrsid6949844 2}{\insrsid6780649 6}{\insrsid6949844 .}{\insrsid4197351 \tab Religion}{\insrsid9906974  / Belief:}{\insrsid1653429  }{
\insrsid4197351  }{\insrsid932477  }{\insrsid4197351 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid14891225 \tab }{\insrsid4091981 Buddhist
\par \tab Christian (all denominations)
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Hindu
\par Jain
\par Jehovah\rquote s Witness
\par Jewish 
\par Muslim
\par Rastafari
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 \tab Sikh
\par \tab No religion
\par \tab Not specified / Unknown
\par \tab Other \tab \tab \tab Please specify 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid12868719 
\par }{\insrsid6949844 2}{\insrsid6780649 7}{\insrsid4197351 .\tab Language}{\insrsid1653429 : }{\insrsid4197351 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14581479 {\insrsid932477 \tab }{\insrsid4091981 Bengali
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 \tab Chinese
\par \tab English
\par \tab Gujarati
\par \tab Hindi
\par \tab Polish\tab 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Punjabi
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 \tab Urdu
\par }{\insrsid7686866 \tab Not English but Unknown}{\insrsid4091981 \tab }{\insrsid7686866 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid4091981 Other European Language
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Not specified / Unknown
\par Other \tab \tab \tab P}{\insrsid4091981\charrsid16328811 lease specify 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16328811 {\insrsid932477 \tab }{\insrsid16003964\charrsid16328811 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid6949844 2}{\insrsid6780649 8}{\insrsid4197351 .\tab }{\insrsid11279022 Occupation}{\insrsid12193016  }{\insrsid9906974 
\par 
\par }{\insrsid6949844 2}{\insrsid6780649 9}{\insrsid4197351 .\tab }{\insrsid7686866 Victim\rquote s living arrangements}{\insrsid1653429 : }{\insrsid11279022 
\par 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid1653429 \tab }{\insrsid4091981 Caravan / Mobile Home\tab 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid4091981 Council Tenant
\par Housing Association}{\insrsid6510345  }{\cf1\insrsid6510345\charrsid5120330 Tenant }{\cf1\insrsid4091981\charrsid5120330 
\par Living with }{\cf1\insrsid3351422\charrsid5120330 F}{\cf1\insrsid4091981\charrsid5120330 amily / Friends}{\cf1\insrsid6510345\charrsid5120330  / Partner}{\cf6\insrsid4091981\charrsid6510345 
\par }{\insrsid4091981 Owner Occupier
\par Private Tenant
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4091981 {\insrsid13653307 \tab Not specified / Unknown}{\insrsid4091981 \tab }{\insrsid13653307 
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13653307 {\insrsid4091981 Other\tab \tab \tab Please specify }{\insrsid9648605 
\par }\pard \ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid1325496 {\cf2\insrsid1325496 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid7686866 {\cf1\insrsid6780649 30}{\cf1\insrsid1325496 .\tab Do}{\cf1\insrsid161434 es the victim have a }{\cf1\insrsid6886272 disability? }{
\cf1\insrsid6833373 Yes }{\cf1\insrsid161434 
\par }\pard \ql \fi720\li3600\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin3600\itap0\pararsid161434 {\cf1\insrsid6833373 No}{\cf1\insrsid1325496   }{\cf1\insrsid1325496\charrsid1325496 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid6833373 {\insrsid7686866 \tab \tab \tab \tab \tab \tab }{\cf1\insrsid7686866 Not specified / Unknown}{\cf1\insrsid6949844 
\par }{\insrsid7686866 
\par }{\insrsid3822664 3}{\insrsid6780649 1}{\insrsid4197351\charrsid143596 .}{\cf2\insrsid4197351\charrsid143596 \tab }{\cf1\insrsid11279022\charrsid6886272 If yes, }{\cf1\insrsid6833373\charrsid6886272 please}{\cf1\insrsid11279022\charrsid6886272  }{
\cf1\insrsid6833373\charrsid6886272 state type of impairment}{\cf1\insrsid6886272\charrsid6886272 /s}{\cf1\insrsid6833373\charrsid6886272  which appl}{\cf1\insrsid8277339 y}{\cf2\insrsid6833373  }{\cf2\insrsid6886272 
\par }{\cf2\insrsid4806844 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid15013863 {\cf2\insrsid6833373 \tab }{\cf1\insrsid15013863\charrsid4351468 
Illness or health condition such as cancer, HIV, MS, diabetes, chronic heart disease, or epilepsy?}{\cf2\insrsid15013863  }{\cf2\insrsid15013863\charrsid4806844 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid6833373 {\cf2\insrsid15013863 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid15013863 {\cf2\insrsid15013863 \tab }{\cf1\insrsid15013863\charrsid4351468 Learning difficulty (such as dyslexia)}{\cf1\insrsid15013863 ?}{
\cf1\insrsid15013863\charrsid4351468 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid6833373 {\cf2\insrsid15013863 
\par \tab }{\cf1\insrsid15013863\charrsid4351468 Learning disability (such as Down\rquote s syndrome}{\cf1\insrsid15013863 )?}{\cf2\insrsid15013863 
\par }\pard \ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid15013863 {\cf1\insrsid15013863 
\par }{\cf1\insrsid15013863\charrsid4351468 Mental health condition, such as depression or schizophrenia}{\cf1\insrsid15013863 ?
\par 
\par }{\cf1\insrsid6833373\charrsid4351468 Physical impairment, such as difficulty using your arms or mobility issues}{\cf1\insrsid4351468 ?}{\cf1\insrsid6833373\charrsid4351468  
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid6833373 {\cf2\insrsid6833373 
\par \tab }{\cf1\insrsid4806844\charrsid4351468 Sensory impairment, such as being blind / having a visual impairment or being deaf / having a hearing impairment}{\cf1\insrsid4351468 ?}{\cf1\insrsid6833373\charrsid4351468 
\par }{\cf2\insrsid4806844 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid15013863 {\cf2\insrsid4806844 \tab }{\cf1\insrsid4806844\charrsid4351468 Other }{\cf1\insrsid14032014\charrsid16328811 please specify}{
\cf1\insrsid14353495  }{\cf2\insrsid4806844\charrsid4806844 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid4806844 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid9979912 {\insrsid9525822 3}{\insrsid6780649 2}{\insrsid4197351 .\tab }{\insrsid1769767 Ethnic origin }{\insrsid9979912  }{\insrsid4197351  }{
\insrsid9979912 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9979912 {\insrsid9979912 
\par }{\insrsid7686866 \tab Asian or British Asian \endash  }{\insrsid9906974 Bangladeshi}{\insrsid7686866 
\par }{\insrsid8075577 \tab Asian or British Asian \endash  Indian
\par \tab Asian or British Asian \endash  Other Asian
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid8075577 \tab }{\insrsid7686866 Asian or British Asian \endash  Pakistani
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7686866 {\insrsid7686866 Black or Black British \endash  African
\par }{\insrsid8075577 Black or Black British \endash  Caribbean
\par }{\insrsid7686866 Chinese
\par Gypsies
\par Irish Travellers
\par Mixed \endash  Other mixed
\par Mixed \endash  White and Asian
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9979912 {\insrsid8075577 \tab Mixed \endash  White and Black {\*\xmlopen\xmlns1{\factoidname place}}Caribbean{\*\xmlclose}
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8075577 {\insrsid8075577 Mixed \endash  White and Black African
\par White \endash  British 
\par White \endash  Irish
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10902892 {\insrsid4197351 \tab }{\insrsid11351944 Not specified / Unkown
\par }\pard \ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11351944 {\insrsid9979912 Other  }{\insrsid14353495 \tab }{\insrsid16328811 please specify }{\insrsid9979912 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10902892 {\insrsid16328811 
\par }{\insrsid11285859 3}{\insrsid6780649 3}{\insrsid10902892 .\tab }{\insrsid9648605 Was }{\insrsid10902892 an interpreter required? Yes/No
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058084 {\b\ul\insrsid2058084 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7764400 {\b\ul\insrsid7764400\charrsid9463653 Section }{\b\ul\insrsid9637463 4}{\b\ul\insrsid7764400\charrsid9463653 : Witness Details (if applicable)

\par }{\insrsid7764400 
\par }{\insrsid6949844 3}{\insrsid6780649 4}{\insrsid7764400 .\tab Witness Name
\par 
\par }{\insrsid6949844 3}{\insrsid6780649 5}{\insrsid7764400 .\tab Relation to victim (if any)
\par 
\par }{\insrsid6949844 3}{\insrsid6780649 6}{\insrsid7764400 .\tab Address
\par }{\insrsid8664052 
\par }{\insrsid6949844 3}{\insrsid6780649 7}{\insrsid7764400 .\tab Postcode
\par 
\par }{\insrsid6949844 3}{\insrsid6780649 8}{\insrsid7764400 .\tab Telephone contact number
\par 
\par }{\insrsid6949844 3}{\insrsid6780649 9}{\insrsid7764400 .\tab Email contact
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058084 {\b\ul\insrsid7764400 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\ul\insrsid12262998\charrsid7217299 Section}{\b\ul\insrsid2058084  }{\b\ul\insrsid9637463 5}{\b\ul\insrsid6622300\charrsid7217299 : Person Reporting }{
\b\ul\insrsid5995338 (if applicable) }{\b\ul\insrsid1589175 please see the guidance notes below at }{\b\ul\insrsid11293215 s}{\b\ul\insrsid1589175 ectio}{\b\ul\insrsid9909123 n }{\b\ul\insrsid11293215 7)}{\b\ul\insrsid9909123   }{
\b\ul\insrsid12262998\charrsid7217299 
\par }{\insrsid6622300 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid10902892 {\insrsid6780649 40}{\insrsid10902892 .\tab }{\insrsid14813019 Are you reporting on behalf of an agency?}{\insrsid10902892  \endash 
 Yes/No }{\insrsid8926726 If yes to which agency:}{\insrsid10902892 
\par }{\insrsid8926726 
\par }{\insrsid4091981 \tab District }{\insrsid6831702 / }{\insrsid4091981 Borough}{\insrsid6831702  Council}{\insrsid4091981 
\par }\pard \ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid8926726 {\insrsid8926726 Leicestershire County Council
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid8926726 {\insrsid8926726 \tab Police
\par \tab Other Agency \tab Please specify  
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid10902892 
\par }{\insrsid3822664 4}{\insrsid6780649 1}{\insrsid4197351 .\tab }{\insrsid6622300 Name of person reporting
\par 
\par }{\insrsid9525822 4}{\insrsid6780649 2}{\insrsid9599573 .}{\insrsid3218378 \tab Relation to victim
\par }{\insrsid14090307 
\par }{\insrsid11285859 4}{\insrsid6780649 3}{\insrsid4197351 .\tab }{\insrsid6622300 Address
\par 
\par }{\insrsid6949844 4}{\insrsid6780649 4}{\insrsid4197351 .\tab }{\insrsid6622300 Postcode
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3218378 {\insrsid3218378 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid6949844 4}{\insrsid6780649 5}{\insrsid4197351 .\tab }{\insrsid6622300 Contact telephone number
\par 
\par }{\insrsid6949844 4}{\insrsid6780649 6}{\insrsid4197351 .\tab }{\insrsid6622300 Contact E-mail
\par }{\b\ul\insrsid7686866 
\par }{\b\ul\insrsid14090307 Section }{\b\ul\insrsid9637463 6}{\b\ul\insrsid14090307 : Further Action}{\b\ul\insrsid5995338  (if applicable) }{\b\ul\insrsid14090307   
\par 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid16463465 {\insrsid14090307 4}{\insrsid6780649 7}{\insrsid14090307 .\tab What action (if any) }{\insrsid14813019 has already been }{
\insrsid14090307 taken in response to this incident: e.g. dealing with the perpetrator?  
\par }{\b\ul\insrsid16463465 
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid5995338 \tab }{\b\ul\insrsid5995338 
\par }\pard \ql \fi-720\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid14090307 {\insrsid14090307 4}{\insrsid6780649 8}{\insrsid14090307 .\tab }{\insrsid14813019 Has any action been taken to support the victim?}{
\insrsid14090307  e.g. advice given
\par }\pard \ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\insrsid14090307  }{\insrsid5995338 
\par }{\insrsid14581479 
\par 
\par 
\par }{\insrsid5995338\charrsid14090307 
\par }{\b\ul\insrsid16209167 Section }{\b\ul\insrsid14090307 7}{\b\ul\insrsid9909123 :}{\b\ul\insrsid16209167  Data Protection Guidance}{\b\ul\insrsid14907750 
\par }{\b\ul\insrsid7764400 
\par }{\insrsid13857742 Person}{\insrsid12473157 al}{\insrsid13857742  information contained }{\insrsid14813019 i}{\insrsid13857742 n this form will be used to help us reduce hate incidents in Leicestershire.  As the information }{\insrsid3495585 above}{
\insrsid13857742  (if }{\insrsid14813019 it }{\insrsid13857742 is about }{\insrsid7764400 
\par }{\insrsid13857742 you) may include sensitive information}{\insrsid14813019 ,}{\insrsid13857742  we }{\insrsid15013863 may }{\insrsid13857742 need your permission to use or share }{\insrsid14813019 it}{\insrsid13857742 .  }{\insrsid3495585 
 This is a requirement }{\insrsid9330838 of}{\insrsid3495585  the Data Protection Act 1998.}{\insrsid13857742  If the information is not about you}{\insrsid16209167 ,}{\insrsid13857742  }{\insrsid16209167 in most circumstances}{\insrsid13857742 
 we cannot process }{\insrsid14090307 
\par }{\insrsid14813019 it}{\insrsid13857742  without the sig}{\insrsid3495585 n}{\insrsid13857742 ed consent of the person you are identifying.}{\insrsid1589175  }{\insrsid11671632 
Circumstances where we may not require permission include where it is considered to be in the vital interests of the person identified that action is taken.}{\insrsid1589175  If sufficient details exist we may contact that person to obtain permission}{
\insrsid16209167  (where necessary)}{\insrsid1589175 .}{\insrsid13857742 
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\par }{\insrsid9637463 Victim}{\insrsid6453369  }{\insrsid9637463 /}{\insrsid6453369  }{\insrsid9637463 Third Party reporting person consents to incidents being referred to }{\insrsid6831702 the }{\insrsid9637463 Hate Incident Monitoring Project 
\par 
\par Signature \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..}{\insrsid7764400  
\par 
\par }{\insrsid9637463 Victim consents / doesn\rquote t consent to incident being referred to }{\insrsid6831702 the }{\insrsid9637463 police 
\par }{\insrsid4732446 
\par }{\insrsid9637463 Signature \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.
\par }}