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					                                        PERSONAL DETAILS

1. FULL NAME:



2. ADDRESS:



3. CONTACT TELEPHONE NUMBERS:



4. E-MAIL ADDRESS:



5. AGE:



6. OCCUPATION:



7. QUALIFICATION:



8. HOURS OF WORK:



9. PLEASE DESCRIBE YOUR GENERAL HEALTH:



10. WERE YOU USING ANY DRUGS OR TRANQUILIZERS AT THE TIME OF THE SIGHTING?



11. ANY EPILEPSY OR ALLERGIES?



12. HOBBIES:



13. RELIGIOUS AND SPIRITUAL BELIEVES:




                     SMITHFIELD UFO RESEARCH INSTITUTE
14. WHAT IS YOUR ATTITUDE TO THE PARANORMAL?



15. HAVE YOU LATELY OR AT THE TIME OF THE SIGHTING HAD ANY STRESSFUL EXPERIENCES?



16. DID YOU OR ANY OTHER WITNESS TO THIS EVENT SUFFER PHYSICAL AND/OR PSYCHOLOGICAL
EFFECTS PRIOR TO, DURING, OR AFTER THIS INCIDENT?



17. HAVE YOU REPORTED THE SIGHTING TO THE MEDIA OR ANY OTHER ORGANISATION?



18. IF YES – WHY?



19. HAVE YOU HAD ANY PREVIOUS PARANORMAL EXPERIENCES, ESPECIALLY SIMILAR ONES?



20. IF YES PLEASE SPECIFY:




                      SMITHFIELD UFO RESEARCH INSTITUTE
                                          CASE INFORMATION


1. DATE OF EVENT:



2. TIME OF EVENT:



3. WHAT WAS THE DURATION OF THE SIGHTING?



4. DID ANYONE ELSE WITNESS THE PHENOMENON?



5. IF YES, PLEASE GIVE DETAILS:



6. WHAT WAS THE EXACT POSITION OF THE PHENOMENON?



7. WHAT WAS YOUR EXACT POSITION WHEN YOU SIGHTED THE PHENOMENON?



8. PLEASE SKETCH AS DETAILED A MAP AS POSSIBLE OF THE AREA – ALSO INDICATING YOUR AND THE
PHENOMENONS POSITION AND DISTANCE:



9. HOW WAS THE LIGHT AND WEATHER CONDITIONS?

THIN CLOUD     HEAVY CLOUD        CLEAR    MIST     DRY   HEAVY RAIN

DRIZZLE    SNOW     WARM     COLD     CALM        WINDY

DARKNESS     DAYLIGHT    DAWN       DUSK     MOON     STARS



10. WHAT WAS THE TEMPERATURE AT THE TIME OF THE SIGHTING?




                      SMITHFIELD UFO RESEARCH INSTITUTE
11. WAS THE OBJECT/PHENOMENA SEEN IN THE VICINITY OF ANY OF THE FOLLOWING?

CIVIL AIRFIELD    MILITARY AIRFIELD/ESTABLISHMENT     AIR ROUTE

POWER LINE       RADIO/TELEVISION MAST   QUARRY/MINE

STREET LIGHTS      RESERVOIR/RIVER/CANAL/LAKE   WOODLAND

FARMLAND     ANCIENT MONUMENT/SITE       URBAN AREA



12. WAS THERE ANY OTHER FEATURES?



13. WHAT WAS THE WITNESS DOING WHEN THE PHENOMENON OCCURRED?



14. PLEASE DESCRIBE IN YOUR OWN WORDS THE CIRCUMSTANCES OF YOUR SIGHTING AND/OR
EXPERIENCE:



15. ATTEMPT TO SKETCH WHAT YOU SAW TO THE BEST OF YOUR ABILITY:




                       SMITHFIELD UFO RESEARCH INSTITUTE
                                       THE PHENOMENON


1. WHAT DID IT DO?



2. WHAT WAS THE COLOUR?



3. WHAT WAS THE SIZE?



4. WAS THERE ANY SMELL?



5. WHAT DISTANCE WERE YOU FROM THE OBJECT?



6. FROM WHAT DIRECTION TO WHAT DIRECTION DID IT MOVE? (I.E. NORTH TO SOUTH)



7. INDICATE ANGLE OF OBJECTS ELEVATION:



8. DID THE OUTLINE OF THE OBJECT APPEAR:

SHARP      FUZZY   TRANSPARENT    STRUCTURED

DETACHED      CONVENTIONAL    UNCONVENTIONAL



9. IF YOU WERE TO COMPARE THE FOLLOWING HELD AT ARMS LENGTH, WHAT WOULD IT REQUIRE TO
COMPLETELY OBSCURE THE OBJECT THAT YOU SAW?

PIN HEAD     MATCH HEAD    PEA   ONE RAND COIN   FIVE RAND COIN

OTHER



10. DID IT MOVE BEHIND ANY OF THE FOLLOWING?

CLOUD      HILLS   TREES   BUILDINGS

OTHER




                      SMITHFIELD UFO RESEARCH INSTITUTE
11. ESTIMATED SPEED OF OBJECT:



12. PLEASE DESCRIBE ANY SOUND:



13. YOU WOULD LIKEN THIS SOUND TO WHAT?



14. DID ANY ANIMAL DISTURBANCE OCCUR?



15. IF YES, WHAT EXACTLY?



16. PLEASE DESCRIBE ANY SPEECH AND FEEL IF THERE WAS ANY:



17. FOR HOW LONG DID YOU OBSERVE THE OBJECT/PHENOMENA?



18. VIEWING METHOD:

NORMAL EYESIGHT     SPECTACLES

BINOCULARS (PLEASE STATE TYPE)

TELESCOPE (PLEASE STATE TYPE)

STD. WINDOW GLASS     DOUBLE GLAZING    CAR WINDOW

OTHER



19. IF YOU OBSERVED THE OBJECT/PHENOMENA WHILE IN A VEHICLE, PLEASE GIVE DETAILS OF TYPE,
MAKE, SPEED, ROAD SURFACE AND SURROUNDING TRAFFIC CONDITIONS. PLEASE MENTION ANY VEHICLE
MALFUNCTION.



20. WAS MORE THAN ONE OBJECT OBSERVED? IF YES PLEASE SPECIFY.



21. DESCRIBE ANY PATTERN OR FORMATION OBSERVED.




                      SMITHFIELD UFO RESEARCH INSTITUTE
22. WAS THE OBJECT/PHENOMENA BRIGHTER THAN THE SKY BACKGROUND?



23. HOW WOULD YOU LIKEN THE BRIGHTNESS?



24. DID THE OBJECT APPEAR SOLID?



25. WERE ANY FIGURES OR THEIR OUTLINES OBSERVED?



26. APPROXIMATE HEIGHT OF OBJECT:

ROOFTOP LEVEL     GROUND LEVEL     BELOW CLOUD     ABOVE CLOUD   VERY HIGH



27. DID THE OBJECT:

HOVER    ROTATE       MOVE ERRATICALLY   EMIT SMOKE/VAPOUR

CHANGE SHAPE      CHANGE COLOUR     EXPLODE   ALTER SPEED    MANOEUVRE



28. WAS ANY PHYSICAL TRACE OR RESIDUE LEFT AT THE SIGHT? PLEASE DESCRIBE:



29. VIDEO OR ANY OTHER RECORDING? (IF YES, PLEASE GIVE DETAIL OF MAKE, TYPE, SPEED, SETTINGS.)



30. DO YOU HAVE ANY OBJECTION TO YOUR NAME OR OCCUPATION BEING PUBLISHED IN CONNECTION
WITH YOUR TING/EXPERIENCE?




                       SMITHFIELD UFO RESEARCH INSTITUTE

				
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Amila Darshana Amila Darshana http://
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