Witness statement — Family Court (Part 22 FPR)

Case No: [CASE NUMBER]

BETWEEN:

[APPLICANT NAME] — Applicant

and

[RESPONDENT NAME] — Respondent

Statement of: [YOUR FULL NAME]

On behalf of: [Applicant / Respondent]

Statement number: [1st / 2nd / 3rd]

Exhibit reference: [INITIALS-1]

Date made: [DD / MM / YYYY]

1. I am [YOUR FULL NAME], date of birth [DD/MM/YYYY], of [ADDRESS — or 'address withheld and known to the court' if a C8 is filed].

2. I am the [Applicant / Respondent] in these proceedings. I make this statement from facts within my own knowledge unless otherwise stated. Where facts are not within my own knowledge I have identified the source.

3. There is now produced and shown to me a paginated bundle of documents marked '[INITIALS-1]' to which I refer in this statement.

4. The Respondent and I began a relationship in [MONTH / YEAR]. We [married / cohabited / had a child together] in [YEAR]. We separated on or around [DATE].

5. We have [NUMBER] child(ren) together: [CHILD'S NAME, DOB], [CHILD'S NAME, DOB].

6. [Briefly describe the current living arrangements and any existing orders.]

7. The pattern of behaviour I describe in this statement falls within the statutory definition of domestic abuse in section 1 of the Domestic Abuse Act 2021 — it includes [physical / sexual / controlling or coercive / economic / psychological] abuse.

8. [Summarise the pattern in 3–5 sentences before giving specific incidents. Re H-N [2021] EWCA Civ 448 emphasises pattern over individual events.]

9. On or about [DATE] at [LOCATION], the Respondent [DESCRIBE EXACTLY WHAT HAPPENED — verbatim words in quotes where possible]. Present at the time were [NAMES]. I recall this happened because [HOW YOU REMEMBER THE DATE — e.g. it was the day after the child's birthday]. I reported this to [POLICE / GP / FRIEND] on [DATE]; see exhibit [INITIALS-1, p.X].

10. [Repeat the same structure for each incident. Use one numbered paragraph per incident.]

11. The effect on me has been [DESCRIBE — sleep, work, mental health, GP attendance, medication].

12. The effect on [CHILD] has been [DESCRIBE — behaviour, school, contact handovers, anything school/CAMHS/GP noted].

13. I remain at risk of [SPECIFY — further violence, harassment, abduction, etc.] for the following reasons: [REASONS].

14. I therefore invite the court to [SPECIFY ORDERS SOUGHT — e.g. a fact-finding hearing; a child arrangements order in the terms set out in Form C100; a Non-Molestation Order; a Prohibited Steps Order].