AI Disclosure Statement
A formal, structured template for declaring the use of AI tools in preparing documents, evidence, or submissions.
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Preview — AI Disclosure Statement
AI Disclosure Statement
Prepared in accordance with the AI Evidence Disclosure Standard v1
1. Declaration of AI Use
I, [Full Name], declare that artificial intelligence tools were used in the preparation of the following materials related to [matter description]:
- [Document 1 — e.g., Claim narrative]
- [Document 2 — e.g., Chronology of events]
- [Document 3 — e.g., Supporting summary]
2. AI Tools Used
| Tool | Version / Model | Purpose |
|---|---|---|
| [e.g., ChatGPT] | [e.g., GPT-4o] | [e.g., Drafting claim narrative] |
| [Tool 2] | [Version] | [Purpose] |
3. Nature of AI Assistance
[Describe how the AI tools were used — e.g., "ChatGPT was used to draft an initial summary of the medical report. The output was reviewed, factual inaccuracies were corrected, speculative content was removed, and the summary was rewritten to reflect the claimant's own account."]
4. Review and Verification Process
All AI-generated content was reviewed by [name / role] for accuracy, completeness, and relevance. Modifications were made as documented in the accompanying evidence log (see 02-evidence-log/).
Refer to the evidence log for a complete, entry-by-entry record of all AI interactions, prompts, outputs, and modifications.
5. Materials NOT Prepared with AI
The following materials were prepared without AI assistance:
- [e.g., Original medical reports]
- [e.g., Photographs and receipts]
6. Attestation
I attest that this disclosure is complete and accurate to the best of my knowledge as at [date].
Signature
Date
Full Name (printed)
What this template covers
- Declaration of all AI tools used in document preparation
- Scope of AI involvement (which documents, what tasks)
- Nature of AI assistance (drafting, summarising, reviewing)
- Human review and verification process
- Materials NOT prepared with AI assistance
- Formal attestation and signature
How to use
- Fill in all highlighted placeholder fields with your specific details
- List every AI tool used, including version/model information
- Describe how AI outputs were reviewed and what changes were made
- Identify materials that were NOT prepared with AI
- Sign, date, and include with your submission materials
Get this template
Request a disclosure pack to receive this template customised to your scenario, along with the evidence log, folder structure, and integrity checklist.
Request a PackThis platform provides process documentation tools only. It does not provide legal advice, is not a substitute for professional legal counsel, and does not certify the truth or accuracy of any information disclosed. All outputs are for documentation purposes only.