Date of interview: Place of detention: Name of Interviewer/Organization: Name of Interpreter:

Vulnerability:  Minor (<18)  Elderly  Victim of Torture  Victim of Trafficking  Victim of SGBV  Medical Emergency  Other Medical Problems / handicapped RISK RATING:  URGENT  URGENT ACTION REQUIRED BY: ______PROFILING QUESTIONNAIRE (mixed migration flows in the Republic of Belarus)

* Possible indication that the individual may be a person of concern to UNHCR and that UNHCR should be notified. † Possible indication that the individual may be a trafficked person and that IOM should be notified. PROFILE 1. Full Name: (SURNAME/first name/other/patronymic) 2. Sex:  Male  Female 3. DOB: ___ /___ /______4. Ethnicity: 5. Citizenship: 6. Country of Residence: 7. City of Residence: 8. Country of Birth: 9. City of Birth: 10. Religion: 11. Marital Status: 12. Language/Literacy: 13. Traveling alone?  Yes  No 14. Accompanying family members and other persons: Name Relationship Sex DOB

15. Documentation (Indicate if docs retained by agents/employers †) Type of document Issuing Country Number Expiry Date Comments

16. Medical/Physical Conditions (Please note if pregnancy, disability or other visible medical or physical concerns, or if a person demonstrates obviously confused thinking (such that responses are often incoherent)t, or behaviour which is regarded as nonsensical, or clearly peculiar behaviour (e.g. hyperactivity, impulsivity, oppositional behaviour), or there is a risk of harm to self or others, etc.).  Normal  NOT Normal: ______

MIGRATION PROCESS 17. When did you leave your country of origin? 18. Why did you leave your place of origin? 19. How did you leave your place of origin? Check or leave only relevant option(s): Check or leave only relevant option(s):  Work opportunity  Self  Study  Facilitated or assisted †  Family reunification  Involuntary (kidnapping, coercion, sold by family) †  Visit friend or to see other places If other, please specify: ______ Marriage ______ False promise or Deception†  Flight from harm or fear of harm* 20. Did you experience arrest/detention/tortures in  Indiscriminate violence* country of origin?  Yes  No  Armed conflict* If yes, please specify (was it based on a court decision?):  Disruption of public order* ______If other, please specify: ______

21. Did you spend any time in transit country(ies): 22. Did you experience arrest/detention/violence†/ torture/  Yes  No If yes, please specify in chronological order: deportation while transiting through other countries?  Yes  No If yes, specify (based on a court decision?): Country Date of arrival Date of departure ______

23. Where you employed in transit country (ies)?  Yes  No If yes, please specify: ______Did you receive money for this activity?  Yes  No † Were you forced to this activity?  Yes†  No

SITUATION IN BELARUS 24. When did you arrive to Belarus? 25. What are your means of subsistence? 26. Status of your stay in Belarus 27. Current procedures Check or leave only relevant option(s): Check or leave only relevant option(s):  Illegal entry  Identification procedure  Illegal stay (legal entry and overstay )  Asylum procedure  Deportation from Belarus  Detention pending deportation  Deportation to Belarus  Crime suspect (which crime?) ______ Legal stay for reason of ______ Other: ______28. Have you been provided by the authorities with info 29. When have you been detained in Belarus? about your rights/obligations in Belarus, in particular:  About possibility to apply for refugee status 30. Do you have any complaints or proposals about conditions of detention?  Yes  No if yes:  About possibility of AVR ______ About possibility to apply to UNHCR/IOM/BRC/RCS ______

2 PROSPECTS

31. What do you think will happen to you if you return to 32. I would like to Check or leave only relevant option(s): your country of origin Check or leave only relevant option(s):  Return to the country of origin  Nothing harmful  Go to other country (specify) ______ Detention, arrest, illegal prosecution *  Apply for refugee status in Belarus  Prosecution for crime committed  Apply for refugee status in other country  Physical violence *†  Stay in Belarus for (study, marriage, work, etc.): ______ SGBV *†  Get medical assistance  Fear of retaliation *†  Call home  Other fFear of return *  Find my relatives  Other: ______ Get more information about my situation ______ Talk with UNHCR  Talk with other organization/person: ______33. Do you have a physical possibility to return to your 34. Do you have anything to add? home country?  Yes  No If no, please specify: ______ Lack of documents ______ Lack of money ______ Bad health I agree that members of monitoring team obtain access to my records and to other documents related to my detention and  Other: ______medical care. Signature of detainee ______CASE ANALYSIS

35. Profile Determination Check or leave only relevant option(s): 36. Assistance provided (as of today):  Economical migrant Nature of Organization Contact Contact  Potential Asylum-seeker assistance name(s) details  Potential Victim of Trafficking  Minor, please indicate if  unaccompanied  Victim of Torture  Health and disability problem  Other: ______FOLLOW-UP 37. Questionnaire has been read back to individual  Yes 38. Referred for Assistance (in the future):

39. Any other comments by interviewer: Nature of Organization Contact Contact ______assistance name(s) details ______

SIGNATURES

3 Interviewer ______Interpreter ______

Document version: 29 January 2010

Check-list for member of monitoring team  Try to obtain a possibility to have a confidential interview with the detainee (as permitted by the authorities and also taking into account detainee’s profile and security precautions).  Introduce yourself; introduce the translator and other monitoring team members in the room.  Make sure that the translator and detainee understand each other.  Clearly state the purpose of visit.  Offer to the detainee information booklets and consultations to help him understand and implement his rights, including:  rights and obligations related to the detention, criteria of a refugee status, procedure of submission of application for recognition as refugee, phases of the refugee status determination procedure, including the right for appealing against actions of officials, etc.;  information on access to the UNHCR, IOM, other international agencies, relevant NGOs (addresses, telephone numbers, reception procedures, information that the aid is provided for free).  Explain to the detainee that answers to questions are voluntary.  Explain the purpose of the notes made by the interviewer in the course of the interview.  Inform the detainee on his right for confidentiality of the information provided by him. Information will not be shared with the authorities of the country of origin without the detainee’s express consent. The detainee should also be advised that this duty of confidentiality applies to everyone in the interview room, including the interpreter.  The detainee should be advised of the obligation to be truthful if he wants to get assistance. The detainee should be advised that if he/she does not know the answer to a question, or if clarification is required, he/she may and should say so.  Allow the detainee before the interview to make remarks or ask questions.  Fill out this Questionnaire.  After finishing the interview ask the detainee whether he would like to add anything to the provided information (see question 34).  Read back the Questionnaire to the detainee and ask him/her to confirm if it is accurate. Make a note in the Questionnaire that this was done (see question 37).  Fill out the UNHCR Registration form with the detainees who have expressed their intention to request asylum in Belarus.  Assist the detainee to fill out the application for refugee status and complementary protection with state authorities or IOM’s AVR form, as appropriate.  Tell the detainee about your next actions related to him.  Receive access to the detainee’s records as well as to other documents related to his detention and medical care provided that they do not contain confidential information based on the detainee’s written consent (see question 34). [in accordance with Article 12 of Chapter 4 of the Memorandum of Understanding of 7 May 2008]  Fill in the monitoring visit report and submit it to your organization and to UNHCR.

4  If violation of the legislation of the Republic of Belarus or the standards of the international law found, inform your organization and UNHCR and, upon consent of your organization, inform the relevant state authority, orally or in writing.

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