Reporter Name Date of Birth Please provide DOB in DD/MM/YYYY format Contact Number Email Address Home Address Postcode Self-Ethnicity White British White Irish White Other Mixed White and Black Caribbean Mixed White and Black African Mixed White and Asian Asian or Asian British Indian Asian or Asian British Pakistani Asian or Asian British Bangladeshi Asian or Asian British other Mixed other Black or Black British Caribbean Black or Black British African Black or Black British other Chinese Not Stated Gypsy or Irish traveller Incident details / Circumstances Please include · Description of offender · Location of incident · What has been seen/heard · Your seat number · Row · Stand · Time of incident Willing to provide statement to police? Yes No Submit This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
