„Book of Names” questionnaire

The Memory of Treblinka Foundation in cooperation with Jewish Historical Institute collects all available information concerning the victims of the extermination camp in Treblinka. 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.

The questionnaire is also available as a word document. Filled and signed should be scanned and sent by e-mail or (original) by mail to Foundation: The questionnaire “Book of Names”.doc

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, we would be very thankful for making them available to us for copying.

As we’d like to be formally entitled to insert the data passed by you into Foundation database, we need your formal confirmation. The questionnaire filled on-line we will send to you. Please sign it and send us back.

If in future you’d like to update sent data please contact Foundation.


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)


Trade (before and after 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 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

I agree to processing and entering to a database my personal data and data about people described in the survey as deported to the extermination camp in Treblinka. The permission is granted to the “Memory of Treblinka” Foundation (as defined in the Act of August 29, 1997 on the Protection of Personal Data (Journal of Laws 2014 item 1182, with later changes) and for processing the data for purposes pertaining to the activity of the Foundation (including transmitting the data to organizations cooperating with the Foundations for purposes pertaining to its activity).