In the Family Court Sitting at C1 Make Sure You Complete This

No. of Witness Statement / 01
On behalf of: / ApplicantMAKE SURE YOU COMPLETE THIS IN LOWER CASE
Date:
No. of Exhibits: / 0

IN THE FAMILY COURT SITTING AT C1 MAKE SURE YOU COMPLETE THIS

Case No.

IN THE MATTER OF AN APPLICATION UNDER PART IV OF THE FAMILY LAW ACT 1996

B E T W E E N :-

Applicant

-and-

Respondent

FIRST WITNESS STATEMENT OF A1MAKE SURE YOU COMPLETE THIS

I, A1, of [address] [a confidential address disclosed to the Court], make this statement believing the contents to be true and knowing that it will be placed before the Court as evidence.

The Respondent, R1, and I are associated persons within Section 62(3) of the Family Law Act 1996 becauseASSOCIATION.

I am making this Witness Statement in support of my application to this Court, made without notice to the Respondent for a non-molestation order.

I was born on DATE and am X years of age. OCCUPATION. ANY KNOWN MEDICAL CONDITIONS OR DISABILITIES MAKE SURE YOU USE FULL SENTENCES

The Respondent, ASSOCIATION, is a OCCUPATION. He was born on DATE and is X years of age. He lives atADDRESS. ANY KNOWN MEDICAL CONDITIONS OR DISABILITIES.

I have X children by the Respondent/from a previous relationship, namely: FULL NAME (Born: DOB).WHERE DO CHILDREN LIVE AND WITH WHOM. DO THEY HAVE ANY MEDICAL CONDITIONS OR DISABILITIES.

I set out below a brief history of the abuse I have suffered from the Respondent to establish why I need the protection of a court order. This statement is being prepared on short notice so that an emergency order can be obtained and, as such, it may not contain all the incidents that have occurred. I have tried to include the main incidents but I seek permission to make a further more detailed statement if necessary to support my application and any future court proceedings.

I first met the Respondent in…. We married in…..

The Respondent has lived with me at my home address between DATE and DATE. My home is a X-bedroom house/flat rented from/privately owned. The tenancy/mortgage is in joint/my sole name. The Respondent and I lived together at a different address between DATE and DATE.

My relationship with the Respondent was initially fine/started well [change as appropriate]. EXPLAIN what it was like, if there are positive statements to be made. Our relationship began to change around ………

The statement needs to deal with the history of the relationship covering, where relevant:

Controlling behaviour (eg over appearance, finances, relationship with family and friends)

Verbal abuse

First incidence of violence/worst incidence of violence/last incident of violence AND a summarising paragraph or 2 paragraphs of intervening violence

The first incidence of violence occurred in ……

When did it happen ? be as accurate as possible
What led up to the incident
The incident itself (what happened. How long did it continue for? What brought it to an end)
Were there any witnesses
What action did the Applicant take afterwards (eg called police, sought medical attention, spoke to other agencies)
If the Applicant did not seek any help, explain why
What action did police take, if involved
Did the applicant suffer any injuries? (include the treatment required, recovery period and if these injuries are still evident)

The worst incident of violence occurred in …..[repeat using above format]

The most recent incident of violence occurred in …..[repeat using above format. MAKE SURE YOU PUT FULL DATE ie include the year]

I am making this application without notice under section 45(2)(a) of the Family Law Act because I believe that I will be at risk of significant harm if the Respondent is not ordered to stop immediately. If this application were made on-notice and he/she were served with the application, I believe he/shewould do me physical harm. The Respondent has been violent and aggressive. I am in imminent danger. The evidence of the harm I have already suffered is set out in my witness statement and I truly believe that unless he/sheis ordered by the court to behave himself the Respondent will continue to cause me significant harm.

MAKE SURE ALL TEXT IS IN BLACK AND YOU DELETE THE RED AS APPROPRIATE

MAKE SURE YOU COMPLETE THE NEXT PAGE

Dated this ______day of ______2018

I believe the facts stated in this witness statement are true.

……………………………………………………………..