Statement

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Sutherland Shire Council witness statement

• Statement in the matter of

• Location statement made
  Address

• Date and time of statement

  Date

• Name of witness

• Address of witness
  Address

• Occupation

• States: This statement made by me accurately sets out the evidence which I would be prepared, if necessary, to give in court as a witness. The statement is true and to the best on my knowledge and belief and I make it knowing that, if it is tended in court as evidence, I shall be liable to prosecution if I have wilfully stated anything which I know to be false or do not believe to be true.

• I am years of age

• Signature of person making statement

  Sign

• Witness to signature

  Sign