same sex assessment form

* Required Field

Name: *
   
Date of Birth: *
   
Address: *
   
Country: *
   
Mobile Phone: *
   
E-mail Address: *

 
Association in a particular social or political group(Political ,religious ,social, LGBT)
 
   
Please advise what your specific situation is in terms of threat to your life or protection from your government because you belong to this group of association
 
   
Do you face persecution at your work place?
   
Do you face persecution from police?
   
Do you face persecution from the church?
   
Do you face persecution from the state?
   
Do you fear for your life?
Do you suffer cruel and unjust punishment?
   
Please give us a brief synopsis as to what danger you face and what is the threat to your life and safety
 

Type Code : verification image, type it in the box


DISCLAIMER

CITRN Canada is assisting the LGTB community with making 'refugee claims. This is applicable only to persons who are genuine and have a fear or threat to life per the guidelines of the Refugee Act. CITRN is not encouraging persons to use the programme illegally or unethically .