WITNESS STATEMENT

Criminal Procedure Rules, r 16.2; Criminal Justice Act 1967, s. 9

The Civil Procedure Rules 1998

URN

Statement of:

Age if under 18:                (if over 18 insert ‘over 18’)

Occupation:

This statement (consisting of                      page(s) each signed by me) is true to the best of my knowledge and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have willfully stated in it anything which I know to be false, or do not believe to be true.

Signature:                 (witness) Date:

I, Mr Simon Paul Cordell, of 109 Burncroft Avenue PO BOX EN3 7JQ.

I WILL SAY AS FOLLOWS

I am client of the London Borough of Enfield by way of being a secure tenant and haver lived in my rented property since the year of 2006.

Signature:

Signature witnessed by:

Witness contact details URN

Name of witness:

Home Address:                                                             Postcode:

E-mail address:                                                             Mobile:

Home Telephone Number:                                             Work Telephone Number: Preferred means of contact (specify details for vulnerable/intimidated victims and witnesses only): Gender:                                                                        Date and place of birth:

Former name:                                                               Ethnicity Code (16 + 1):

DATES OF WITNESS NON-AVAILABILITY:

Witness care

a) Is the witness willing to attend court?                  If ‘No’, include reason(s) on form MG6.

b) What can be done to ensure attendance?

c) Does the witness require a Special Measures Assessment as a vulnerable or intimidated witness? (youth under 18; witness with mental disorder, learning or physical disability; or witness in fear of giving evidence or witness is the complainant in a sexual offence case)            If ‘Yes’ submit MG2 with file in anticipated not guilty, contested or indictable only cases.

d) Does the witness have any particular needs?            If ‘Yes’ what are they? (Disability, healthcare, childcare, transport, disability, language difficulties, visually impaired, restricted mobility or other concerns?).

Witness Consent (for witness completion)

a) The Victim Personal Statement scheme (victims only) has been explained to me          Yes            No

b) I have been given the Victim Personal Statement leaflet                                          Yes            No

c) I have been given the leaflet “Giving a witness statement to the police…”                  Yes            No

d) I consent to police having access to my medical record(s) in relation      Yes             No             N/A to this matter (obtained in accordance with local practice)

e) I consent to my medical record in relation to this matter being                Yes             No             N/A disclosed to the defence

f) I consent to the statement being disclosed for the purposes of civil,       Yes             No             N/A or other proceedings if applicable, e.g. child care proceedings,

CICA

g) Child witness cases only. I have had the provision regarding              Yes             No             N/A reporting restrictions explained to me.

I would like CPS to apply for reporting restrictions on my behalf.             Yes             No             N/A

‘I understand that the information recorded above will be passed on to the Witness Service, which offers help and support to witnesses pre-trial and at court’.

Signature of witness:                                                     PRINT NAME:

Signature of parent/guardian/appropriate adult:               PRINT NAME:

Address and telephone number (of parent etc.), if different from above:

Statement taken by:                                                      Station:

Time and place statement taken: