Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Reporter *Reporter's Email AddressReporter's Phone NumberName of Victim *Victim's Phone NumberDate of Violation *What case types does the Violation fall under? *KidnappingTheftRapeExtortionHarassmentConversion TherapyMob AttackKitoSexual AssaultWrongful DismissalArbitrary ArrestDiscriminationForceful EvictionBlackmailDefamationBattery &AssaultInvasion of PrivacyThreat to LifeIntimate Partner ViolenceChoose at least one (1) and not more than three (3)Case Summary *Kindly provide a complete account of the violation being reportedPerpetrators of Reported ViolationState Actors ( Police, Government Officials, etc)Non-State Actors ( Friends, Family, Neighbors, etc )State & Non-State ActorsWhat is/are the Victim(s)'s Gender identity?Transgender Man (you were born female, but identify as male)Transgender Woman (you were born male, but identify as female)Cisgender Man (If you were born male, and still identify as male)Cisgender Woman (you were born female, and still identify as female)Gender Non-Binary (You do not identify as strictly a man or a woman)Intersex (you were born with sexual or reproductive anatomy that doesn’t seem to fit the typical definitions of female or male)What is/are the Victim(s)'s Sexual Orientation?? *GayLesbianBisexualPansexualAsexualQueerLocation of Violation *What is the status of the violation *OngoingAlready HappenedHow would you like LIRAD Nigeria to come in?Submit
