/ WITNESS statement FORM
  1. GENERAL INFORMATION (to be completed by the party)

  • The Witness presented by («Last Name/First Name)*:
/ ______
  • The Dispute («Dispute») casenumber on eJust*:
/ ______
  • Arbitrator (do not complete if unknown):
/ ______
  1. WITNESS IDENTITY (to be completed by the witness)

  • First name(s)*:
/ ______
  • Last name(s)*:
/ ______
  • Dateof birth*:
/ ______Place of birth*: ______
  • Address*:
/ ______
  • City*:
/ ______Postal code*:______
  • Country*:
/ ______
  • Profession*:
/ ______
  • Link with the other Party*:
/ ______
(Reference is made to a possible family relationship,alliance or subordination, collaboration or community of interest (hereafter "a link" with the Party). Indicate "none" if you do not have any link with the Party.
  1. TESTIMONY (to be completed by the witness)

Indicate the facts you have personally witnessed.

______

  1. DATESIGNATURE (to be completed by the witness by hand, with a blue pen)

  • Place*:
/ ______
  • Date*:
/ ______
  • Signature*:

With his/her signature, the Witness certifies that:

  • The identity declared in section 2 is his/her own.
  • The data filled in section 2 are accurate and complete.
  • He has personally witnessed the facts reported in section 3 or has personally observed these facts.
  • He was warned of the fact that false testimony may result in legal proceedings (see eJust Rules of Arbitration, Article 22, §7).

5.Reminder to the attention of the party who produces the testimony

  • This form must be sent to the Party with its other exhibits on the eJust Platform,in support ofthe facts that its testimony intended to prove.
  • This form must be dated and signed with a blue pen by the Witness (see eJust Rules of Arbitration, Article 22, §4).
  • The Party must also send a two-sidedcolor scanned copy of the Witness' identity card (see eJust Rules of Arbitration, Article 22, §7) on the eJust platform.

Public Document–13.04.2016© eJust1|6