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The Four Rights Request

A hidden judgment touched your life. Put your name back in the record and make power answer. The request runs locally in your browser and leaves through your hands alone.

Put the judgment on record

THE DECISION DOES NOT GET TO DISAPPEAR BEHIND THE INTERFACE.

You were affected. You have the right to ask what touched the result, whose objective it served, who can change it, and how the damage will be repaired.

YOUR NAME IS NOT A SCORE.
YOUR QUESTION IS NOT A REQUEST FOR MERCY.

YOUR RECORD STAYS YOURS. This page has no submission endpoint. The builder runs locally. Do not place unnecessary medical, financial, identity, credential, or third-party private data into a public report.

SectorInstitution or organizationYour name or chosen identifierReference or case numberResponse deadlinePreferred response method

Brief description of the decision

Editable request

Subject: Request for Notice, Reasons, Human Appeal, and Repair

I am requesting information and review concerning a decision, classification, ranking, restriction, or outcome that materially affected me.

1. NOTICE
Please confirm whether an automated, algorithmic, statistical, AI-assisted, scoring, ranking, profiling, recommendation, or generated-summary system materially influenced the outcome. Identify the system role, responsible institution, decision date, and case reference.

2. REASONS
Please provide an understandable explanation of the principal factors that shaped the result, including relevant source records, policies, criteria, objectives, material inferences, and known uncertainty.

3. HUMAN APPEAL
Please provide access to an accountable human reviewer with sufficient time, information, independence, and authority to reconsider and, where appropriate, reverse the outcome.

4. REPAIR
If the decision or its data is wrong or materially incomplete, please explain the process to correct the source record, update downstream systems, reverse the outcome where justified, and restore what was wrongly lost.

Please identify the review procedure, deadline, expected response time, and office or person responsible for the final decision. I am preserving this request and the response as part of my record.

Name:
Reference:
Date:
Preferred response method:

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This template is a civic instrument, not legal advice. Applicable rights, deadlines, and remedies vary.

Before sending

Preserve the version that left your hands.

The movement needs a record that can be compared later.

Save the evidence

Keep the original notice, screenshot, date, policy, source records you submitted, and the final request.

Set the clock

Record the applicable deadline or the response date you requested. Silence becomes legible when it has a date.

Protect privacy

Share only what is necessary to establish the process. Redact account credentials, medical details, financial records, and uninvolved people.

Create a field record Review publication standards

SEND IT. DATE IT. KEEP IT.
POWER CAN DENY THE REQUEST. IT CANNOT ERASE THE QUESTION.