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CIA Witness Statement Form 443

                    WITNESS STATEMENT

                 (CJ Act 1967, s9 MC Act 1980 s102; MC Rules 1981 r 70)

Statement of:...............................................................................................................

Age if Under 18  (if over 18 insert ‘Over 18’)  Occupation..............................................

This statement (consisting of page(s) each signed by me) is true to the best of my knowledge and belief
and I make it knowing that, if it is tendered in eveidence, I shall be liable to prosecution if I have wilfully
stated in it anything which I know to be false or do not believe to be true.

Signed................................................................ Dated.................................................

Signature............................................... Signature witnessed by....................................           1
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