SJ-753B (2015-07) - D claration de la victime / Victim Impact Statement. D claration de la victime (article 722(4) C.cr.) - Formule 34.2 (article 672.5(14) C.cr.) - Formule 48.2 / Victim Impact Statement (Section 722(4) Cr.C.) - Form 34.2-2025

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SJ-753B (2015-07) - D claration de la victime / Victim Impact Statement. D claration de la victime (article 722(4) C.cr.) - Formule 34.2 (article 672.5(14) C.cr.) - Formule 48.2 / Victim Impact Statement (Section 722(4) Cr.C.) - Form 34.2 Preview on Page 1

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  1. Click ‘Get Form’ to open the SJ-753B in the editor.
  2. Begin by filling in the 'Identification du dossier' section, including details about the accused and the victim. If multiple accused are involved, you can complete one form for all cases.
  3. In the 'Répercussions d’ordre émotif' section, describe how the offence has affected you emotionally. Consider your lifestyle, relationships, and emotional responses.
  4. Next, address the 'Répercussions d’ordre physique' section. Detail any physical impacts such as pain, discomfort, or medical treatments resulting from the offence.
  5. Proceed to 'Répercussions d’ordre économique'. Here, outline any financial losses incurred due to the offence, including property damage and medical expenses.
  6. In 'Craintes concernant la sécurité', express any fears for your safety or that of your loved ones related to contact with the offender.
  7. Utilize the space provided for a drawing, poem, or letter if it helps convey your experience.
  8. Finally, sign and date the form at the bottom. If completed on behalf of someone else, provide reasons and your relationship to them.

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A victims impact statement letter should include: ​ A *brief* summary of the harm or trauma suffered by the victim or family as a result of the crime. ​ A summary of the economic loss or damage suffered by the victim as a result of the crime. Include requests for restitution for out-of-pocket expenses.
Example: Every morning when I wake up, I have to remind myself that my attacker wont be able to hurt me today. If I dont tell myself that I simply cant get out of bed. Since I was assaulted I have lost the full function of my right leg.
Victim impact statements describe the emotional, physical, and financial impact you and others have suffered as a direct result of the crime.