This is from Pepipoo, so if you win your case then donate your £60 to the site, as I will.


WITNESS STATEMENT
(C.J. Act 1967, s9 MC Act 1980, ss. 5A (3a) and 5B. M.C. Rules 1981, r70)

Name:........................... Occupation:................

D.o.B:........................... Over 18
__________________________________________________ ___________________
This statement consisting of 1 page 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.

Dated....................... Signed................................
__________________________________________________ ___________________

Their Ref: NIP reference number
Vehicle registration number

Dear Chief Constable,

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:

ALL OF THE DETAILS REQUIRED ON THE NIP – name, address, date of birth, driver number etc. etc.

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]. Therefore, it is my understanding that, and this statement and the information in it is submitted subject to the condition that, it may not and will not "be given in evidence to a court in a prosecution".

Yours sincerely,

Signature of driver

Name of Driver