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


Contact details

Details of the incident - Part A

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

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


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?