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Annex 12 Victim Statement Form
If you decide to make a statement, please use the attached form. The guidance booklet, 'Making a Victim Statement: Guidance for Victims' and the prompts contained in the form will give you guidance to help you complete it. The guidance pack also contains contact details of organisations that can help you to complete your victim statement.
If you are completing this form because a family member has died, please state how the crime has affected you and any close family members. If the victim is not capable of filling the form out him/herself or is a child under the age of 14, please state the effect on the victim, taking any references to 'you' in the form to refer to the victim.
Please give information on the impact that the crime has had on you/the victim. Remember that you should not include any views about the accused person or the sentence in your victim statement. Remember too that what you say must be truthful and that deliberately giving false information to the court is against the law.
The form has 6 sections. Please read the form first and then complete each section.
The questions provided in the form act as a guide. If a question is not relevant to the effect of the crime on you/the victim, please write 'not applicable' or 'n/a' in that box. If you wish to include information that is not covered by the questions, there is a box at the end of the form for you to give additional information.
Once you have completed the form, please return it in the pre-paid envelope provided by [insert date].
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