PACT Support Request for Adults

This referral provides information to volunteer PACT Support Persons to enable PACT to adequately prepare and support adult complainants or witnesses for the criminal court process. Once we receive a referral, PACT will allocate it to one of our PACT Support Persons who will be in touch with the complainant/witness.

PACT Adult Witness Referral Form

Occurrence #

Pros. index:

Date submitted:

ADULT COMPLAINANT/WITNESS DETAILS

Family name: *

Complainant/witness last name

Given name(s): *

Complainant/witness first and middle names

Date of birth: *

DD/MM/YYYY

Gender:

Gender of complainant/witness

Ethnicity:

Ethnicity of complainant/witness

*If other ethnicity, describe here:

Type of witness:

Current residential address: *

Address of complainant/witness

Suburb and State: *

Postcode: *

Current phone no: *

Phone # of complainant/witness

Email:

Email of complainant/witness

OFFENDER'S DETAILS

Offender's Family name:

Offender's Given name(s):

COURT DETAILS

Court details

Committal

Trial

Court date:

DD/MM/YYYY

Court location:

List charges in which the complainant or witness is required to give evidence:

Are there any problems with this case that are not listed on this form?

Yes

Further information:

SUBMITTED BY:

Full name: *

First name and surname of person submitting the form

Organisation (if applicable):

Phone no: *

Phone number of person submitting the form

Email:

Email address of the person submitting the form

The complainant/witness has given permission for the Office of the Director of Public Prosecutions, the Queensland Police Service, and Protect All Children Today to obtain, share and provide information between organisations for the complainant/witness listed in this referral form.

Consent received

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PACT Support Request for Adults

PACT Adult Witness Referral Form

THANK YOU FOR YOUR REFERRAL TO PACT

Contact Info

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