1. Employee Statement Form
I...........................................................................................................................by occupation
A................................................................................................................................................
At...............................................................................with mobile contact No………………………..
Place……………………………… Age………………………………….
Employee No………………………………………Nationality……………………………………………
Division…………………………………………….Department……………………………………………
Declare that the following statement is true to my knowledge & beliefs, and that I make this statement knowing that if
it is tendered in evidence that I will be liable to prosecution if I willfully state in it anything which I know to be false or
do not believe to be true.
I make this statement out of my own free will and without any promise threat made to me.
This report is made on (Date)…………………… (Time)……………….am/pm at The Torch Doha in the presence of
(Name).........................................… (Designation).........................................
Statement submitted and signature by…………………………………………………..........................
Date…………………………………………………………..Time…………………………………………
Statement taken by………………………………………………………………………….