Statement
Date and time statement was written:
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Name and title of person giving statement:
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This statement is regarding (who / what):
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Details (be specific and descriptive):
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I declare that the statement above, which I have given has been read back (to) me.
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I understand the content of this statement and I declare that it truly and correctly records the information given by me.
Signature
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DD/MM/YY
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Month
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Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Work Number
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When completing or reviewing a statement, the following must be included:
The date and time the statement was written
Who wrote the statement, including their title
Who / what the statement is about
The sequence of events, in chronological order
Very specific and descriptive detail, including:
Times within the details
Names and titles of people
Specifics of what was said, rather than general comments
A sequence of events that are accurate and include all information. The more descriptive the statement the better
Do not include any personal or subjective comments on a statement.
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