This document contains an employee statement form that collects information such as the employee's name, occupation, place of work, contact details, employee number, nationality, and division/department. The employee declares that the following statement is true to their knowledge and that they understand they could face prosecution if they provide any false information. They also confirm they are providing the statement voluntarily without any promises or threats being made. The form collects the date, time, and location of where the statement is being made as well as the names of those involved in the statement. The employee then provides their signature and the statement is taken by another individual.