Name *

Email *

Phone *

Choose Category *Anti-Muslim hateAntisemitismAnti-Christian hateAnti-Buddhist hateAny other type of hate

Type of incident (please tick as many as apply) *

• Abusive Behaviour
• Threatening Behaviour
• Assault
• Vandalism
• Discrimination
• Hate Speech
• Anti-Muslim Literature
• Online content or abuse

Date and time on which incident happened

Date

Time

Please provide a brief description of incident *

Location *

Address Line 1

City

State / Province / Region

Postal Code

CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Upload a photo/video of the incident (25 MB maximum)

Click or drag files to this area to upload. You can upload up to 5 files.

Did this incident happen to you? *

• No, I am a witness
• No, I am reporting on behalf of someone else
• Yes (please fill out your details below)

Gender

• Male
• Female
• Non-binary
• Other
• Unknown

Select Age GroupUnknown12 and younger13-1819-2526-3536-4546-5556-65Over 65

Ethnicity1. Unknown---------- White ----------2. British3. Irish4. Irish Traveller or Roma5. Any other White background---------- Black / African / Caribbean / Black British ----------6. African7. Caribbean8. Somali9. Any other Black background---------- Asian / Asian British ----------10. Indian11. Pakistani12. Bangladeshi13. Chinese14. Sri Lankan15. Afghan16. Any other South Asian background---------- Mixed / Multiple ethnic groups ----------17. White and Black Caribbean18. White and Black African19. White and Asian20. Any other Mixed / Multiple ethnic background---------- Other ethnic group ----------21. Arab22. North African23. Jewish24. Any other ethnic group

Please provide information about the perpetrator

Gender

• Male
• Female
• Non-binary
• Other
• Unknown
• Multiple/Group

Select Age GroupUnknown12 and younger13-1819-2526-3536-4546-5556-65Over 65

Ethnicity1. Unknown---------- White ----------2. British3. Irish4. Irish Traveller or Roma5. Any other White background---------- Black / African / Caribbean / Black British ----------6. African7. Caribbean8. Somali9. Any other Black background---------- Asian / Asian British ----------10. Indian11. Pakistani12. Bangladeshi13. Chinese14. Sri Lankan15. Afghan16. Any other South Asian background---------- Mixed / Multiple ethnic groups ----------17. White and Black Caribbean18. White and Black African19. White and Asian20. Any other Mixed / Multiple ethnic background---------- Other ethnic group ----------21. Arab22. North African23. Jewish24. Any other ethnic group

How did you hear about us? *

• Word of Mouth
• In the press
• Online/Social Media
• Referred by Police
• Referred by Another Organisation
• 'Stop/Report' Wallet Card
• Search Engine
• Other

Submit