Client Summary Statment

Please complete the form below

You can also download the form and email to mail@cullenmacleod.com.au

Declaration

I insert name, of address, occupation, provide the following summary of my situation. I have cross-referenced the relevant documents below as Attachments ‘1’ onwards where relevant.

I agree to provide all relevant information, both positive and negative, so that my lawyers can organise my best possible position and be forewarned of (and prepare for) any issues that may arise at a later stage.

My signature to this document below is on the basis that I, not any third party, have provided the information below and believe the information to be true and correct. Where I am not sure about any of the information I have made that very clear. I understand that my lawyer will rely on the information below. If my memory of any of the events below changes, I will contact my lawyer and update this information.

Personal Details

Name

I was born in this country

I was born on this date

I live at

Address Line 2 City State / Province / Region ZIP / Postal Code Country

Professional Background

Short summary of your professional background and qualifications.

Subject Matter of the Statement

Summary of the reason you are providing this proof of evidence which explains the basis of the dispute.

Background to the Dispute

The dispute began in

The dispute relates to this person

I knew this person prior to this because

I have been involved in this industry since

Chronological summary of what has occurred, including meetings, conversations, and what people said and did.

Dispute Itself

The dispute occurred because

Chronological summary of what has occurred, including meetings, conversations, and what people said and did.

I Want / The Other Side Wants

What do you want from the other side?

What does the other side want from you?

Losses

I believe the losses I have suffered amount to

Summary of the details of the losses and calculations.

Outcome

The outcome I am seeking is

Miscellaneous

Summary of anything that might be relevant to the dispute. It is better to include everything and then to reduce the information down to what is directly relevant, rather than leave something out which you did not realise was important.

Signature

Date