38 MODUL 3 : INSTRUMEN DAN MEKANISME HAM LEMBAR KERJA KELOMPOK Instrumen dan Mekanisme HAM Internasional PEDOMAN PENGADUAN INDIVIDUAL Tanggal …….........................……….........…. To 1 • Human Rights Committee (HRC) atau • Committee Againts Torture (CAT) atau • Committee on the Elimination of Racial Discrimination (CERD) atau • Committee on the Elimination of All Form of Discrimination Againts (CEDAW) Women c/o UN Office of High Commissioner for Human Rights 8 - 14 Avenue de la Paix 1211 Geneve 10 Tel: (41 22) 917 9240 Fax: (41 22) 917 9012 www. unhchr.ch Switzerland I. Informasi Umum penulis pengaduan Nama : ...................................................................................................................................... Nama Depan : ...................................................................................................................................... Kewarganegaraan : ...................................................................................................................................... Tempat/ Tgl lahir : ...................................................................................................................................... Alamat : ...................................................................................................................................... Alamat Rahasia : ............................................................................................................( jika diperlukan) Mengajukan Pengaduan sebagai *2) : a. Korban b. Wakil/penasihat hukum yang diangkat oleh korban *3) c. Lain-lain *4) II. Informasi Korban (jika penulis pengaduan bukan korban) Nama : ...................................................................................................................................... Nama Depan : ...................................................................................................................................... Kewarganegaraan : ...................................................................................................................................... Pekerjaan : ...................................................................................................................................... Tempat/ Tgl lahir : ...................................................................................................................................... Alamat : ...................................................................................................................................... M O D U L P E G A N G A N PA RT I S I PA N : P E L AT I H A N DA S A R H AM - K O M N A S H A M 2 0 1 5