Filed on behalf of the Claimant

Witness Statement of [insert initial and surname of witness]

Number of witness statement: [insert number of witness statement in relation to the witness]

exhibit details: [insert initials and number of each exhibit referred to]

Date on which statement was made: [insert date]

[Date of translation: [insert date]]

Parties

1. A        Claimant

1. and

1. B        Defendant

________________________________

WITNESS STATEMENT OF [insert full name]

________________________________

I, [insert full name], of [insert full address and occupation] will say as follows:

1. 1. 1

      The facts and matters set out in this witness statement are within my own knowledge unless otherwise stated, and I believe them to be true.

   1. 2

      [I drafted this witness statement myself and these are my own words. OR This witness statement was prepared on my behalf by [insert name and/or role of person who drafted the document] following discussions [in person OR over the telephone OR [insert other form of communication] AND/OR [through an interpreter.]]]