Online Form - Rangers - Dog Attack Statement - Victim/Injured Party

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Do you speak and understand English?*
Are you affected by alcohol or any drugs?*
Would you be willing to attend court to give evidence?*

Personal information

Gender*

Contact details

Current residential address

I became aware of an incident regarding an alleged dog attack by:


Details of the incident - Part A

Location of the incident

Details of the incident - Part B

Were there any witnesses to the incident? If Yes, provide names and contact details on the next page*

Witness details


Details of the incident - Part C

The dog/s involved in the attack is/are described as follows:

Gender of the dog
I can identify the attacking dog/s?*
I can identify the attacking dog/s owner?*

Details of the incident - Part D

Did you sustain injuries as a result of the attack?*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx
Did your pet sustain injuries as a result of the attack?*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Details of the incident - Part E


Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Declaration

Have you been made any promises or inducement to provide this statement?*
Is this statement made of your own free will?*
Have you been threatened by any person to make this statement?*
Do you agree this is a true statement?*
Do you understand that by making this statement that if it is tendered in evidence I will be guilty of a crime if I have willfully included in this statement anything, which I know to be false, or that I do not believe to be true?*

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