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A Guide to what you need to include in a Victim Impact Statement - Primary Victim(s) of Crime

Victim Impact Statement - Primary Victim(s)
(Crimes (Sentencing Procedure) Act 1999, section 30)

1.Name of victim(s):
 
Name of offender:
 
Charge/s to which this statement relates:
 

 

 

Sentencing Court:
 
Sentencing Date:
 
2.Details of personal harm suffered as a direct result of the offence(s):
 
Physical bodily harm
 
 
 
 
 
Mental illness or nervous shock
 
 
 
 
 
3.Attached to this statement are the following medical or other specialist reports:
 
 
 
4.To be completed where this statement is prepared by a victim's representative
Nature of relationship to primary victim:
 
 
Duration of relationship to primary victim
(unless a relative by blood or marriage):
 
Nature of primary victim's incapacity:
 
 
5.To be completed where this statement has been prepared by the victim himself or herself, or by the victim's representative. Delete whichever is inapplicable.
This statement is true to the best of my knowledge and belief

 

or

I have not told any lies in this statement
(where the person preparing this statement is less than twelve (12) years old)
 
 
 
 

_____________________

  

____________________
Signed Dated
(victim or victim's representative)  
 
 
6.To be completed where this statement is prepared by a qualified person on behalf of the victim(s)
This statement is true to the best of my knowledge and belief.
 
 
 
 _____________________  _____________________
SignedDated
 
 
I do not object this statement being given to the court:
 
 _____________________ 
_____________________
SignedDated
(victim(s))

 
 
 

_______________________

Sun Button Click here to see the Guide to what you need to include in a Victim Impact Statement - Family Victim


Sun Button Click here to read about Victim Impact Statements


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The information contained on this page is not legal advice. If you have a legal problem you should talk to a lawyer before making a decision about what to do. The information on this page is written for people resident in, or affected by, the laws of New South Wales, Australia only.

most recently updated 12 August 2004