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A Guide to things you need to include in a Victim Impact Statement - Family Victim
Victim Impact Statement - Family Victim(s)
(Crimes (Sentencing Procedure) Act 1999, section 30)

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

 

 

Sentencing Court:
 
Sentencing Date:
 
2.Details of impact of death of the primary victim on the family victim(s), being the member(s) of the immediate family of the primary victim(s):
 
 
 
 
 
 
3.Attached to this statement are the following medical or other specialist reports:
 
 
 
4.To be completed where this statement has been prepared by the family victim himself or herself. 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(s))  
 
 
5.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
(family victim(s))

 
 
 

____________________

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


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