Witness statement — Criminal (MG11 style)

Statement of: [YOUR FULL NAME]

Age if under 18 (if over 18 insert 'over 18'): [AGE]

Occupation: [OCCUPATION]

Date: [DD / MM / YYYY]

Tick if witness evidence is visually recorded: [ ] (Supply witness details on rear of form)

I am the above-named person. I make this statement in connection with [an offence of … on … / events between … and …].

[Begin chronological account here in your own words. State date, time, location, what happened, what was said — quote verbatim where possible — who was present, what you did afterwards (e.g. called 999, attended A&E), and any visible injuries or damage.]

The suspect is my [relationship — e.g. former partner]. Our relationship began in [MONTH / YEAR] and ended in [MONTH / YEAR]. Throughout the relationship I have experienced [summarise the pattern — controlling and coercive behaviour under s.76 Serious Crime Act 2015 / stalking under s.2A or s.4A Protection from Harassment Act 1997 / non-fatal strangulation under s.75A Serious Crime Act 2015]. The most recent incidents are set out above.

Previous incidents reported to police include: [DATE — CAD/CRIS number — brief summary]. I confirm I am content for police to obtain those records.

Injuries: [DESCRIBE EACH INJURY, LOCATION ON BODY, PAIN SCORE, WHETHER PHOTOGRAPHED, WHO TOOK PHOTOS AND WHEN].

Exhibits handed to police: [ITEM — EXHIBIT REF — DATE].

Digital evidence: [WHATSAPP / SMS / EMAIL THREADS, FROM AND TO DATES; BACKED UP WHERE].

[NAME] [PHONE] [WHAT THEY SAW OR HEARD].

I would like the following special measures considered: [screens / live link / pre-recorded evidence-in-chief / cross-examination under s.28 YJCEA 1999 / removal of wigs and gowns / clearing the public gallery].

Reason: [BRIEF REASON].