CICA TEMPLATE

PHOTOGRAPHIC EVIDENCE FOR CICA Name of Client: Arend Von Weilligh Date of Accident: 15/10/2008 Date Photographs Taken: 03/05/2011 NATURE OF INJURY: Scarring to abdomen Globe House, Love Lane, Cirencester, Gloucestershire, GL7 1YGTel 01285 658111 Fax 01285 658108 Dx 39408 Cirencester Email [email protected] www.photofileltd.co.uk



1. Identification photographs of Arend Von Wielligh.

STATEMENT OF AUTHENTICITY I, David Kilburn declare as follows: The photographs taken of Arend Von Wielligh on the 3rd day of May 2011 at 3:45pm are a true representation and have not been retouched or manipulated in any way whatsoever. Signed __________________________ Dated ___________________________STATEMENT OF AUTHENTICITYI, David Kilburn declare as follows: The photographs taken of Arend Von Wielligh on the 3rd day of May 2011 at 3:45pm are a true representation and have not been retouched or manipulated in any way whatsoever.Signed __________________________Dated ___________________________

2. Photographs showing scarring to Arend Von Wielligh’s abdomen.

STATEMENT OF AUTHENTICITY I, David Kilburn declare as follows: The photographs taken of Arend Von Wielligh on the 3rd day of May 2011 at 3:45pm are a true representation and have not been retouched or manipulated in any way whatsoever. Signed __________________________ Dated ___________________________STATEMENT OF AUTHENTICITYI, David Kilburn declare as follows: The photographs taken of Arend Von Wielligh on the 3rd day of May 2011 at 3:45pm are a true representation and have not been retouched or manipulated in any way whatsoever.Signed __________________________Dated ___________________________