​ሕግንና ደንብን በተመለከተ እርዳታ ማግኘት ይፈልጋሉን? - Amharic | هل تحتاج لمساعدة قانونية؟ - Arabic | ܤܢܝܼܩܵܐ ܝ݇ܘ̤ܬ ܠܗܲܝܵܪܬܵܐ ܩܵܢܘܿܢܵܝܬܵܐ؟ - Assyrian | Need Legal Help? - Auslan | Treba li vam pravna pomoc? - Bosnian | Burmese â Need Legal Help? | 需要法律帮助吗? - Chinese Simplified | 需要法律幫助嗎? - Chinese Traditional | Trebate li pravnu pomoć? - Croatian | ضرورت به کمک قانونی دارید؟ - Dari | Wïc Kuɔɔny në Wɛ̈t Löŋ? - Dinka | آیا به کمک حقوقی نیاز دارید؟ - Farsi | Gadreva na Veivuke Vakalawa? - Fijian | Kailangan ninyo ba ng tulong na panglegal? - Filipino | Besoin d’aide juridique ? - French | Χρειάζεστε βοήθεια σε νομικά ζητήματα - Greek | क्या आपको कानूनी सलाह चाहिए? - Hindi | Butuhkan Bantuan dalam Masalah Hukum? - Indonesian | Hai bisogno di assistenza legale? - Italian | ត្រូវការជំនួយលើបញ្ហាផ្លូវច្បាប់ឬទេ? - Khmer | 법적인 도움이 필요하십니까? - Korean | Ви треба ли помош со правни работи? - Macedonian | कानूनी सहयोग चाहिएको छ? - Nepalese | Necessita de ajuda com questões jurídicas? - Portuguese | Вам нужна юридическая помощь? - Russian | E Manaomia Fesoasoani i Mea Tau Tulafono? - Samoan | а ли вам треба помоћ у правним питањима? - Serbian | Ma u baahan tahay Caawimmad xagga sharciga ah?- Somali | ¿Necesita ayuda con cuestiones jurídicas? - Spanish | சட்ட உதவி தேவையா? - Tamil | ท่านต้องการความช่วยเหลือทางด้านกฎหมายไหม? - Thai | Fiema’u ha tokoni Fakalao? - Tongan | Yasal Danışmaya İhtiyacınız mı var? - Turkish | Cần Được Giúp Đỡ Về Luật Pháp? - Vietnamese |

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Sample protected person witness statement

Icon - sample/instructionsThis is a sample of a witness statement. It is not legal advice.

For help preparing a witness statement, see Instructions for preparing witness statements.

If you need more help, get legal advice​.


Statement of Elizabeth Smith

I, Elizabeth Smith, of 12/100 Victoria Road, Double Bay NSW 2028, aged 36, nurse, state:

  1. Gary Smith (Gary) and I have been married for 4 years.

  2. Gary and I have an 18-month old daughter, named Dakota Smith.

  3. Until recently Gary and I resided at 12/100 Victoria Road, Double Bay NSW 2028.

  4. Gary is a salesman.

  5. In or about August 20XX, Gary lost his job and has been unemployed since that date.

  6. Since August 20XX I have been the only person making money in my family. I am employed as a nurse at the Wayside Mercy Medical Clinic.

  7. On Sunday, 3 November 20XX, Gary and I were at home. My daughter was sleeping in her cot in her bedroom. Gary and I were talking about bills and our recent spending, when we began arguing about our financial situation.

  8. Gary started yelling at me and waving his fists in the air, screaming "You're useless and lazy."

  9. I tried to leave the room but Gary blocked my path. I tried to go around Gary again and he pushed me and I fell over onto my right arm. I immediately felt a sharp pain and screamed out in pain. Gary then turned and left the house.

  10. I got up and tried to clean up the mess in the lounge room. I was in so much pain I went and woke up my daughter and drove to the Prince of Wales Hospital.

  11. When I saw the doctor, he ordered some x-rays. I was later advised that I had a fractured ulna (forearm). The doctor bandaged my arm and gave me a prescription for some pain medication.

  12. I was afraid to go home but I didn't have anywhere else to go.

  13. Gary came home the next morning at about 10.00am. I tried to talk to him about what happened and we had a conversation in words to the following effect:

    ES: "Gary, we need to talk."
    GS: "Shut-up, I don't want to talk to you."
    ES: "Please don't yell, you will wake Dakota."
    GS: "Then don't make me angry."

  14. Gary then grabbed a vase and threw it at the wall.

  15. I heard Gary go into our bedroom. He then walked past me carrying a bag and slammed the door on his way out.

  16. When I went into the bedroom I noticed that my laptop was missing.

  17. The next day I sent Gary a text message with words to the effect of:

    "Please return my laptop. I need to pay the mortgage and electricity. They are due tomorrow."

    Gary did not reply.

  18. Gary has been verbally abusive to me in the past. He has also thrown objects but this is the first time he has physically hurt me.

  19. Since losing his job, Gary has been drinking heavily, often finishing a six-pack of beer every night. This makes him more agitated and aggressive.

  20. I want protection from Gary, as I am afraid that he will come back and hurt me again.

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

Signed: E. Smith                               Witnessed: A. Lagi
Dated: 17 December 20XX               Dated: 17 December 20XX​