Missing Person Number/Code:
(Use unique numbering and include it on associated
files, photographs or stored objects.)

Interviewer name:

Interviewer contact details:

Interviewee(s) name(s):

Relationship with missing person:

Contact details
Address:____________________________________________________________________________
Telephone:__________________________________ E-mail:___________________________________

Contact person for missing person, if different from above: (who to contact in case of news: name/contact details)

A.1

Missing person’s name

Include surname, father’s and/or mother name, nicknames, aliases:

A.2

Address/Place of residence

Last address & usual address if different from the former:

A.3

Marital status

Single

Married

Divorced

Widowed

Partnership

A.4

Sex

Male

Female

A.5

If female

Unmarried name:

Pregnant

Children

How many?

A.6

Age

Date of birth:

Age:

A.7

Place of birth, nationality, principal language

A.8

Identity document(Main details, N°, etc.)

If available, enclose photocopy of ID

A.9

Fingerprints available?

Yes

No

Where:

A.10

Occupation

A.11

Religion

B.1

Circumstances leading to disappearance:(use additional sheet if necessary)

Missing Person alive (incl. name and address):

Has this case been registered/denounced elsewhere?

Yes

No

With whom/Where:

B.2

Are other family members missing, and if so, have they been registered/identified?

List name, relationship, status:

C.1

General description (indicate exact measure, or approximate AND circle the corresponding group)

Height (exact/estimated?):

Short

Average

Tall

Weight:

Slim

Average

Fat

C.2

Ethnic group/Skin color

C.3

Eye color

C.4

a) Head hair

Color:

Length:

Shape:

Baldness:

Other:

b) Facial hair

None

Moustache

Beard

Color:

Length:

c) Body hair

Describe

C.5

Distinguishing features Physical e.g. shape of ears, eyebrows, nose, chin, hands, feet, nails; deformities

Continue on additional sheets if needed. Use drawings and/or mark the main findings on the body chart.

Skin marks scars, tattoos, piercings, birth-marks, moles, circumcision, etc.

Past injuries/amputations include location, side, fractured bone, joint (e.g., knee), and if person limped

Other major medical conditions operations, diseases, etc.

Implants pacemaker, artificial hip, IUD, metal plates or screws from operation, prosthesis, etc.

Types of medications used at time of disappearance

C.6

Dental condition

Please describe general characteristic, especially taking into account the following:

• Missing teeth

• Broken teeth

• Decayed teeth

• Discolorations, such as stains from disease, smoking or other

• Gaps between teeth

• Crowded or crooked (overlapping) teeth

• Jaw inflammation (abscess)

• adornments (inlays, filed teeth etc)

• any other special feature

Dental treatment

Has the Missing Person received any dental treatment such as

• Crowns, such as gold capped teeth

• Color: gold, silver, white

• Fillings (incl. color if known)

• False teeth (dentures) upper, lower

• Bridge or other special dental treatment

• Extraction

Also indicate wherever there is uncertainty (for example, the family member may know that an upper left front tooth is missing, but is unsure which one).

If possible, use a drawing, and/or indicate the described features in the chart below

If the missing person is a child, please indicate which baby teeth have erupted, which have fallen out and which permanent teeth have erupted and use the chart below

BABY/PRIMARY TEETH

ADULT/PERMANENT TEETH

D.1

Clothing (worn when last seen/at time of disaster)

Type of clothes, colors, fabrics, brand names, repairs: describe in as much detail as possible.

D.2

Footwear (worn when last seen/at time of disaster)

Type (boot, shoes, sandals), color, brand, size: describe in as much detail as possible.

D.3

Eyewear

Glasses (color, shape), contact lenses: describe in as much detail as possible.

D.4

Personal items

Watch, jewelry, wallet, keys, photographs, mobile phone (incl. number), medication, cigarettes, etc: describe in as much detail as possible.

D.5

Identity documents (which the person was/might have been carrying when last seen/at time of disaster)

Identity card, driving license, credit card, video club card, etc. Take photocopy if possible. Describe the information contained.

D.6

Habits

Smoker (cigarettes, cigars, pipes), chewing tobacco, betel nut, alcohol, etc. Please describe, incl. quantity.

D.7

Doctors, medical records, X-rays

Give details of doctor, dentist, optometrist, or other.

D.8

Photographs of missing person

If available, enclose photos or copies of photos as recent and clear as possible, (with teeth visible). Also, photos of clothing worn when disappeared.