AI Disclosure Statement Template
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AI Evidence Disclosure Standard v1

1. Overview
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[Describe the context and purpose of this AI disclosure. Include the
matter name or reference, the date range, and the party making the
disclosure.]


2. AI Tools Used
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[List each AI tool used, including the provider, product name,
model/version, and the purpose for which it was used.]

Tool:           ____________________
Provider:       ____________________
Model/Version:  ____________________
Purpose:        ____________________


3. Scope of Use
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[Detail which tasks AI assisted with, such as drafting, analysis,
summarisation, translation, research, or other tasks. Specify which
documents or evidence items were processed.]


4. Review Process
-----------------
[Document who reviewed the AI outputs, what qualifications or role
they hold, and what modifications were made to the AI-generated
content before use.]

Reviewer Name:  ____________________
Role/Title:     ____________________
Date Reviewed:  ____________________
Modifications:  ____________________


5. Limitations
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[Note any known limitations of the AI tools used, including potential
for inaccuracies, hallucinations, bias, or gaps in coverage. State
any caveats about the outputs.]


6. Signoff
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I confirm that the information in this disclosure is accurate to the
best of my knowledge.

Name:       ____________________
Role:       ____________________
Date:       ____________________
Signature:  ____________________
