Online Form - Rangers - Dog Attack Statement - Witness


Navigate through the different form sections using the navigation on the left, or use the next/previous buttons located at the bottom of each step.

Save Your Progress

You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Note: Incomplete forms are kept for a period of 2 day(s), after this time the system will automatically delete your response.

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

Details of the incident - Part A

Location of the incident

Details of the incident - Part B

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 C

Were there any other persons/animals involved in the attack? *

Details of the incident - Part D

Maximum size of ALL attachments is 976.56 MB


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? *

Validate and Submit Form

Get Audio Code


If you've encountered a problem with the website or have any general feedback, please provide comment via this form.

Was this page helpful?