| Details required | Notes |
|---|---|
Details of application 1. Give a description of the communication needs of the witness: 2. State why you consider that the quality of the evidence given by the witness would be improved by use of an intermediary: 3. Give the name of the person through whom it is proposed the examination of the witness be conducted: 4. What is the occupation of this person and what is the person’s area of specialism: 5. Is this person related to the witness? If not related to the witness, does the intermediary know the witness and, if so, how and to what extent? 6. Is this person registered with the Intermediary Registration Board? 7. Why do you consider this person has the necessary skills to meet the particular communication needs of the witness: 8. Has this person been used in the pre-trial investigation? 9. Communication aids— (a) give details of any device used or which it is intended to use as a communication aid: (b) are there any issues which arise as a result of this device being used? | Where an assessment has been undertaken by a relevant professional, give details of where and by whom the assessment was carried out. If the person is not registered with the IRB, give the reason why this person is preferred to an IRB registered person. If so, give reasons why it is proposed to use the same person throughout the proceedings. Give details of any devices that may be used and how they are operated. Examples might be: (a) whether breaks might be needed for the witness and/or the intermediary: (b) the facilities that may be needed for the use of the devices, for example power sources. |
Signature of applicant or applicant’s Solicitor: | Date: |