Witness Statement Template

This Witness Statement is made on [Date] by:

Full Name of Witness: [First Name Last Name]
Address: [Full Address]
Phone/Email: [Contact Information]
Occupation: [Job Title or “N/A”]
Relationship to Case/Parties: [State if applicable]

1. Introduction

I, [Witness Name], make this statement to record my account of the events described below. This statement is true to the best of my knowledge and belief.

2. Event Details

• Date of Incident: [MM/DD/YYYY]

• Time: [Time]

• Location: [Address or description of location]

• People Involved: [List names if known]

3. Statement of Facts

[Provide a clear and chronological description of what was witnessed. Include specific details, observations, and actions taken. Example: “At approximately 8:30 a.m., I saw a blue car traveling at high speed….”]

4. Supporting Evidence

The following documents or exhibits are attached in support of this statement:

• [Exhibit A: Photographs]

• [Exhibit B: Medical Report]

• [Exhibit C: Police Report]

5. Declaration of Truth

I declare that the facts stated in this witness statement are true to the best of my knowledge and belief. I understand that making a false statement may result in penalties under perjury laws.

Signature

Witness Signature: _______________________ Date: ___________
Printed Name: ___________________________

Witnessed/Certified by (if applicable): ________________________
Role/Title: ______________________________ Date: ___________