Reparation Form - Paid Back

If you know someone of African descent who has received slavery reparations please let us know. The information that you provide in the form will help us keep track of individuals who are not registered with us that have already been paid back for slavery and oppression.

FINANCIAL REPARATION -- ALREADY PAID

Name of the individual*
First Last
Address of the individual
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth of individual
Provide information regarding the reparation source for example the date the financial reparation was paid and by whom. Please provide as much information as possible.