Form PC-05 · Statement of Circumstance

File no. PC-0000/26

Date

Issues 0

1. Subject select one

Turning up very late to work
Missing a deadline
Not showing up to a wedding
Still owing somebody money
Leaving a message on read
Not seeing the gym all month
Leaving a party after 15 minutes

2. Tone of address

Straight-faced Creative Unhinged

3. Statement of circumstance

Select a subject above, then issue the statement.

4. Plausibility assessment office use only

--/100

Awaiting a statement.

Authorised on behalf of the bearer

DAY 05/30