Creating a Safer North Wales

The information that you include on this form is dealt with confidentially by specialist officers within North Wales.

IMPORTANT

This form will be received and processed during normal office hours.
If you require an immediate response please contact your nearest police station or in an emergency please phone 999.

Incident / Information

Tell us about the incident that happened to you or somebody else. Please give as many details as possible but don't worry if you can't remember everything.

What happened? Please include hate crime element * Required info
When did it happen? * Required Info	Approx time of day
	Day
	Date
Has this happened before?	Yes No
Where did this incident happen? * Required Info
How many offenders where there?	0 1 2 3 4 5 6 7 8 9 10+
Did you know them? If so please give details.
Did anyone witness what happened?	Yes No
Are you happy to give details of the witnesses?	Yes No
Please give details of the witness(es)