Victim Impact Statement Form
A victim impact statement form is used in the proceedings in a court for criminal justice process and to gather information about the physical, financial and emotional torture that a victim had to go through. The form shows the process in which the statement given by the victim and it is used to pass judgment in the court of law.
Sample Victim Impact Statement Form:
Report number of the police incident: ________________
Police reference number: ________________
Name of the defendant: ____________
Name of the convicted person: _________________
Details of the victim:
Name of the victim: _______________
Gender: _______________
Date of birth: __________
Address: ____________________________
Contact number: __________
How would you like to tell the court that how the offence has affected you?
a) By reading out your statement to the court
b) Give your statement verbally
c) An official appointed by the court will read it out
Do you wish any compensation from the offender?
____________
Details of impact on the victim by the offender:
_________________________________________________
Category: Statement Forms
