Have you witnessed or been a victim of a race or religious hate incident? By reporting it, you're helping us to make a change.
Date of incident (dd/mm/yy)
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Have you reported this incident to the Police or another agency?
Do you want someone to contact you offering more support, sign-posting and guidance?

Your incident has been submitted, if you'd like to tell us about yourself then please complete the following, your information will not be shared with any other organisation or agency unless you give specific consent.