Witness Statement

Witness Statement Submission Portal

This field is hidden when viewing the form

Enter Access Code

Do you agree to keep your report confidential and not discuss the incident with others?(Required)

Agree

DO NOT UNTICK THIS BOX OR REMOVE THE ACCESS CODE OTHERWISE YOUR DATA WILL BE ERASED.

Incident details

Incident report number(Required)

Incident Date(Required)

Incident Time(Required)

Aircraft involved(Required)

Personally involved(Required)

Your Basic Details

First Name(Required)

Family Name(Required)

Email(Required)

Mobile Phone(Required)

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 Town / City State / Province / Region Post Code Country

Upload Photographic ID(Required)

Max. file size: 32 MB.

Passport or Driving licence

Identity Document Number(Required)

Expiry(Required)

Evidence Upload

Have you been asked to upload evidence?(Required)

Yes

Upload Kneeboard Image

Max. file size: 32 MB.

Upload Plog

Max. file size: 32 MB.

Upload Evidence Files

Drop files here or

Max. file size: 32 MB.

NAME YOUR FILES TO MAKE THEM EASY TO UNDERSTAND WHAT THEY ARE BEFORE UPLOADING

Witness Statement(Required)

You must provide an accurate witness statement, this should be factual and not engage in conjecture. What you write forms part of a formal investigation and may be provided to the regulator or government Regulatory body. NAC will not share this statement with third parties other than for the purpose of retaining the data electronically within our systems and online service providers..

Other people involved

Do we need to talk to anyone else regarding this incident (Name and contact details and why we should talk to them)

Completion

By signing this form you are confirming that you understand the process of the investigation and that you have made a factual statement on the events as you have witnessed or been subject of. You confirm that you have told the truth without omitting crucial information pertinent to any investigation.

Sign by entering your Full Name(Required)

Date(Required)