PACE Witness Statement

This page is intended to help you to prepare and print your PACE Witness Statement.

Please bear in mind that this is your Witness Statement and you will be entirely responsible for its content. Only you know what's been asked and what the answers are - we can't help you with the content!

To use this form, fill in the information required and then click on the "Prepare printable version" button at the bottom of the page; the page will then display again complete with your answers, in a format that you can either print directly from your browser, or select and copy for pasting into a word processor.

If you use Microsoft Word and prefer to prepare the statement yourself you can download a proforma in Word 2000 format by clicking here.

Text that looks like this just provides guidance in completing the form - it doesn't appear in the final witness statement.


(C.J. Act 1967, s9: MCA 1980, s102: M.C. Rules 1981, r70)

Your full name: forename(s) surname
Your occupation/job
Your date of birth: d/m/yyyy


This statement consisting of page(s) and attached NIP/ S 172 Notice is true to the best of my knowledge and belief and I make it knowing that if it is tendered in evidence 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.

Date on which you are signing this statement (usually today!): d/m/yyyy
Signed: ................................................


NIP reference number:
Their reference number, shown on the NIP
Vehicle registration number:
The vehicle registration number shown on the NIP


The person you're sending the statement to (normally this should be the Chief Constable of the force that issued the NIP)
Further to the above Notice of Intended Prosecution: I confirm that the following individual was driving the above vehicle at the time of the alleged motoring offence:

Use the lines below to provide all of the information requested in the NIP. For each piece of information requested, put the type of information in the first box on a line, and your response in the second box. In the first few lines we've given examples of information that's commonly requested, but you should use the specific questions you've been asked in your NIP.

As this statement is provided under threat of criminal penalty [Funke v France] and as I have not received the caution required by paragraph 10.1 of PACE Code C [Mawdesley -v- the Chief Constable of Cheshire [2004] 1 All E.R. 58], I make this statement on the express understanding that it shall not be used or disclosed in any proceedings of whatever nature against myself.

Yours faithfully,

Don't forget to:

  • Sign the completed statement here after you've printed it!
  • Write "Please see the attached" on the NIP (and only that!)
  • Attach the NIP to this statement
  • Post the completed statement by Special Delivery