This will appear at the top of your completed statement.

We will send your completed statement to this address. You can also use it to save your progress and come back later.

Choose the option that best fits your situation.

An approximate date or year is fine. You do not need to know the exact date.

This may appear in your statement. You can leave this blank if you prefer.

How did you feel when this happened, or in the days and weeks right after?

Think back to that time. Some people felt scared, shocked, or numb. Others felt angry, ashamed, or confused. Write about what those early days were like for you. What was going through your mind? How did your body feel? How did you get through it?

Has this affected your mental health and emotional wellbeing?

You might write about anxiety, depression, post-traumatic stress, trouble sleeping, nightmares, or flashbacks. If you have seen a psychologist, psychiatrist, or doctor for your mental health because of what happened, mention that here. If you have been given a diagnosis or prescribed medication, you can include that too.

If you have not seen anyone but have noticed real changes in how you think or feel day to day, that is worth writing about as well.

How has this affected your relationships with the people in your life?

Think about your partner, your children, your family, your friends, or your community. Has the way you connect with people changed? Have you pulled away from others? Do you find it harder to trust people now?

If the crime was committed by someone close to you, you can write about the impact of losing that relationship too.

Has this affected your body or your physical health?

You might write about injuries at the time, ongoing pain, changes to your sleep, appetite, or energy, or physical symptoms that have come up since this happened. If you have needed medical treatment or ongoing care, include that here.

The physical effects of trauma are not always obvious. Changes in how your body feels, how tense you are, or how safe you feel in your own skin are all worth including.

Has this cost you money, or affected your ability to work or earn an income?

You might write about lost work or income, the cost of medical treatment or counselling, legal costs, or the cost of moving or replacing things that were lost or damaged. If the offender controlled your money or stopped you from working, describe what that meant for you day to day.

This section can also help if you plan to apply for financial assistance through your state's victims of crime scheme.

How has this changed your day to day life?

Think about things you used to do that you no longer do, or find harder now. Leaving the house. Sleeping. Concentrating. Looking after your kids. Spending time with friends. Things that used to feel normal.

Are there places you avoid now? Things you have had to stop doing? Write about those here.

How has this changed the way you feel about your safety?

Do you feel safe at home? In public? Around other people? Have you changed where you live, how you get around, or how you go about your day because of fear? If you are still afraid of the offender, or worried something like this could happen again, you can say that here.

Losing your sense of safety is one of the most serious effects a crime can have. Courts take this seriously.

Has this affected your spiritual life, your culture, or your sense of meaning and belonging?

This question is for anyone whose faith, spirituality, or sense of purpose has been affected by what happened.

It is especially relevant for Aboriginal and Torres Strait Islander people. For many Aboriginal and Torres Strait Islander people, harm can affect connection to Country, cultural and ceremonial obligations, community relationships, and spiritual wellbeing in ways the other questions may not cover. If this applies to you, use this space to describe that in your own words. You do not need to use formal or clinical language.

If this question does not apply to you, you can skip it.

Tell us about who you were before this happened. What did your life look like.

This is one of the most important questions in your statement. The court needs to understand what your life was like before, so they can understand what has changed.

You might write about your work, your family, your interests, your personality, or your plans for the future. What did a good day look like? What were you working toward?

You do not have to paint a perfect picture. Just be honest about who you were.