“Book of Names” questionnaire

The Memory of Treblinka Foundation collects all available information concerning the victims of the extermination camp in Treblinka, as well as about people who escaped on their way to Treblinka or from the camp. We do not want to allow for them – as the Nazis would have wished – to remain anonymous. Every name is important to us. If you would like to share with us any information about your family or friends, we would be very grateful for completing on-line questionnaire below. Even just a partially completed questionnaire would be very valuable to us.

Comments on completing the survey:
Data of more than one person can be sent in separate or in one questionnaire. If you do not know the exact date of birth, please give an approximate one. If the detailed address is missing, then maybe just district or town is known.
If you have any souvenirs, letters, photographs or other documents pertaining to the people you’re describing, you can attach them to the survey  as a pdf file.
If in future you’d like to update sent data please contact Foundation.
To put the survey in the database, we need your formal signature. Therefore, it is important to sign the survey on the screen.
The questionnaire “Book of Names”.doc is also available as a word document. Filled and signed by hand should be scanned and sent by e-mail or (original) by mail to Foundation.
The survey (after completing it using the form below, signing it on the screen and saving it on your computer) can be sent directly via the website. Choose the button below and attach the survey as a PDF file on the next screen.

SEND THE COMPLETED QUESTIONNAIRE

Thank you!

QUESTIONNAIRE

    Name and surname – if applicable, names used previously, in the case of women – maiden names

    Date and place of birth

    Place of residence (before and during the war – in which ghetto was the person placed)

    Parents’ names (mother’s maiden name)

    Education

    Trade (before and during the war)

    Place of death

    Other information, e.g. date and place of deportation, circumastances of the deportation of a given person (or family). If you have a longer story to tell, we will contact you to hear it or you can send it to us via email or mail.

    Spouse (name and surname, date of birth, trade)

    Children – names and dates of birth (age), other information, e.g. names of schools, participation in organizations

    Alternatively, please list other people who were murdered in Treblinka

    In what relation to you was the person (people) described?

    What is the source of information about the person described? (obligatory)

    Name and surname of the person completing this questionnaire (obligatory)

    Contact details – email address (obligatory)

    Contact: address and telephone (obligatory)

    Date of completing the questionnaire

    Please verify that all data is completely correct, after going to the next page you will only be able to send or reject the data.

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