Future Covid-19 Human Rights Accountability Proceeding

“United to witness violations of Universal Human Rights, in the name of justice and in service to a
vision of the future where all are united in peace and harmony.”
______________________________________________________________________________

VIOLATION FORM – V1:

I, _________________________________, during the Covid-19 pandemic, have experienced a violation

of my rights as expressed in the Universal Declaration of Human Rights, in the Nuremberg Code, and in
hu-man rights and civil rights legislation of nations around the world. I offer this testimony in service of a
world united in peace and justice.

☐I was denied my right to informed consent to the experimental Covid-19 vaccine.

☐I was coerced into receiving the experimental Covid-19 vaccine.
☐I, or someone close to me, was harmed by the experimental Covid-19 vaccine.
☐I was punished for refusing the experimental Covid-19 vaccine.
☐I was discriminated against because of my Covid-19 vaccination status.
☐other (described below)

I write my particular experience here (attaching ____sheets):

Description:

1
I certify that I experienced the violation described above. I certify that I am recording this in the interest of human
rights and justice. I certify that I am not acting out of personal animosity to any person that may be named herein.

1. Name: Date:

Place: Signature:

2. Commissioner: Date:

Place: Signature:

Contact: Phone:

Email: Address:

Save or scan the completed form with any additional documents and send as an email attachment to covidwitness@maatlegal.ca