View source for Criminal Code Forms (Form 6 to 30)

{{seealso|Criminal Code Forms}}
==Form 6 - Summons to Accused ==
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{{FormHeader1
| FORM 6
| (Section 2)
| Summons to a Person Charged with an Offence
}}

To (name of person), of ________________, born on (date of birth):

Because you have this day been charged with (set out briefly the offence in respect of which the accused is charged);

Therefore, you are ordered, in Her Majesty’s name:
:(a) to appear on (date) at (hour) at (place) for the purposes of the ''Identification of Criminals Act'' (Ignore, if not filled in); and
:(b) to attend court on (date), at (hour), at (place), or before any justice for the (territorial division) who is there, and to attend court at any time after as required by the court, in order to be dealt with according to law.

You are warned that, unless you have a lawful excuse, it is an offence under subsection 145(3) of the Criminal Code to fail to appear for the purposes of the ''Identification of Criminals Act'' or to attend court, as required in this summons.

If you commit an offence under subsection 145(3) of the Criminal Code, a warrant for your arrest may be issued (Section 512 or 512.1 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

If you do not comply with this summons or are charged with committing an indictable offence after it has been issued to you, this summons may be cancelled and, as a result, you may be detained in custody (Subsection 524(4) of the Criminal Code).

Signed on (date), at (place).

________________

(Signature of judge, justice, clerk of the court or chairperson of the Review Board)

________________

(Name of the judge, justice or chairperson)

|}
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==Form 7 - Warrant for Arrest==
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{{FormHeader1
| FORM 7
| (Sections 475, 493, 597, 800 and 803)
| Warrant for Arrest
}}

To the peace officers in the said (territorial division):

This warrant is issued for the arrest of A.B., of ____________, (occupation), hereinafter called the accused.

Whereas the accused has been charged that (set out briefly the offence in respect of which the accused is charged);

And whereas:*
:(a) there are reasonable grounds to believe that it is necessary in the public interest to issue this warrant for the arrest of the accused [507(4), 512(1)];
:(b) the accused failed to attend court in accordance with the summons served on him [512(2)];
:(c) (an appearance notice or a promise to appear or a recognizance entered into before an officer in charge) was confirmed and the accused failed to attend court in accordance therewith [512(2)];
:(d) it appears that a summons cannot be served because the accused is evading service [512(2)];
:(e) the accused was ordered to be present at the hearing of an application for a review of an order made by a justice and did not attend the hearing [520(5), 521(5)];
:(f) there are reasonable grounds to believe that the accused has contravened or is about to contravene the (promise to appear or undertaking or recognizance) on which he was released [524(1), 525(5), 679(6)];
:(g) there are reasonable grounds to believe that the accused has since his release from custody on (a promise to appear or an undertaking or a recognizance) committed an indictable offence [524(1), 525(5), 679(6)];
:(h) the accused was required by (an appearance notice or a promise to appear or a recognizance entered into before an officer in charge or a summons) to attend at a time and place stated therein for the purposes of the ''Identification of Criminals Act'' and did not appear at that time and place [502, 510];
:(i) an indictment has been found against the accused and the accused has not appeared or remained in attendance before the court for his trial [597];
:(j) **

This is, therefore, to command you, in Her Majesty’s name, forthwith to arrest the said accused and to bring him before (state court, judge or justice), to be dealt with according to law.

(Add where applicable) Whereas there are reasonable grounds to believe that the accused is or will be present in (here describe dwelling-house);

This warrant is also issued to authorize you to enter the dwelling-house for the purpose of arresting or apprehending the accused, subject to the condition that you may not enter the dwelling-house unless you have, immediately before entering the dwelling-house, reasonable grounds to believe that the person to be arrested or apprehended is present in the dwelling-house.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

Judge, Clerk of the Court, Provincial Court Judge or Justice

*Initial applicable recital.

**For any case not covered by recitals (a) to (i), insert recital in the words of the statute authorizing the warrant.

R.S., {{LegHistory80s|1985, c. C-46}}, Form 7; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s.203; {{LegHistory90s|1997, c. 39}}, s. 3; {{LegHistory90s|1999, c. 5}}, s. 46.
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==Form 7.1 - Warrant To Enter Dwelling-house==
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{{FormHeader1| FORM 7.1
| (Section 529.1)
| Warrant To Enter Dwelling-house
}}

To the peace officers in the said (territorial division):

This warrant is issued in respect of the arrest of A.B., or a person with the following description (____________), of ____________, (occupation).

Whereas there are reasonable grounds to believe:*
:(a) a warrant referred to in this or any other Act of Parliament to arrest or apprehend the person is in force anywhere in Canada;
:(b) grounds exist to arrest the person without warrant under paragraph 495(1)(a) or (b) or section 672.91 of the Criminal Code; or
:(c) grounds exist to arrest or apprehend without warrant the person under an Act of Parliament, other than this Act;

And whereas there are reasonable grounds to believe that the person is or will be present in (here describe dwelling-house);

This warrant is issued to authorize you to enter the dwelling-house for the purpose of arresting or apprehending the person.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

Judge, Clerk of the Court, Provincial Court Judge or Justice

*Initial applicable recital.

{{LegHistory90s|1997, c. 39}}, s. 3; {{LegHistory00s|2002, c. 13}}, s. 85.
|}

==Form 8 - Warrant for Committal==
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{{FormHeader1| FORM 8
| (Sections 493 and 515)
| Warrant for Committal
}}

To the peace officers in the (territorial division) and to the keeper of the (prison) at ________________:

This warrant is issued for the committal of (name of person), of ________________, born on (date of birth), referred to in this warrant as the accused.

Because the accused has been charged with (set out briefly the offence in respect of which the accused is charged);

And because (check those that are applicable):
:□ (a) the prosecutor has shown cause why the detention of the accused in custody is justified [515(5)];
:□ (b) a release order has been issued but the accused has not yet complied with the conditions of the order [519(1), 520(9), 521(10), 524(8), 525(6)];*
:□ (c) the application by the prosecutor for a review of the release order has been allowed and that release order has been vacated, and the prosecutor has shown cause why the detention of the accused in custody is justified [521];
:□ (d) the accused has contravened or was about to contravene a (summons or appearance notice or undertaking or release order) and it was cancelled, and the detention of the accused in custody is justified [515(10), 523.1(3), 524(3) and (4)];
:□ (e) there are reasonable grounds to believe that the accused has committed an indictable offence after having become subject to the (summons or appearance notice or undertaking or release order) and the detention of the accused in custody is justified [515(10), 524(3) and (4)];
:□ (f) (if none of the above applies, reproduce the provisions of the statute that authorize this warrant).

Therefore, you are ordered, in Her Majesty’s name, to arrest the accused and convey them safely to the (prison) at ________________, and there deliver them to its keeper, with the following order:

You are ordered to receive the accused in your custody in this prison and keep them safely there until they are delivered by due course of law.

Signed on (date), at (place).

________________

(Signature of judge, justice or clerk of the court)

________________

(Name of the judge or justice who has issued this warrant)

*If the person having custody of the accused is authorized under paragraph 519(1)(b) of the Criminal Code to release the accused if they comply with a release order, endorse the authorization on this warrant and attach a copy of the order.

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==Form 9 - Appearance Notice==
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{{FormHeader1|FORM 9
| (Section 2)
| Appearance Notice
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1 Identification

Surname: ________________ Given name(s): ________________

Date of Birth: ________________

2 Contact Information

________________

3 Alleged Offence

You are alleged to have committed (set out briefly the substance of the offence, including any failure referred to in section 496, that the accused is alleged to have committed).

□ (Check if applicable) No new charges are being laid against you at this time but you are required to appear at a judicial referral hearing under section 523.1 for a failure under section 496.

4 Conditions

You must attend court as indicated below, and afterwards as required by the court:

Date: ________________

Time: ________________

Court number: ________________

Court address: ________________

5 Appearance for the purposes of the ''Identification of Criminals Act'' (if applicable)

□ You are required to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act.

6 Consequence for non-compliance

You are warned that,
:(a) in the case where charges have been laid against you, unless you have a lawful excuse, you commit an offence under subsection 145(3) of the Criminal Code if you fail to appear for the purposes of the ''Identification of Criminals Act'' or to attend court, as required in this appearance notice;
:(b) in the case where no charges have been laid against you and you fail to appear at a judicial referral hearing under section 523.1, as required in this appearance notice, charges may be laid against you for the alleged offence described in item 3 of this notice.

If you commit an offence under subsection 145(3) of the Criminal Code, a warrant for your arrest may be issued (section 512 or 512.2 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

It is not a lawful excuse to an offence under subsection 145(3) of the Criminal Code that this appearance notice does not accurately describe the offence that you are alleged to have committed (subsection 145(6) of the Criminal Code).

If you do not comply with this appearance notice or are charged with committing an indictable offence after you have been released, this appearance notice may be cancelled and, as a result, you may be detained in custody (subsection 524(4) of the Criminal Code).

7 Signatures

ACCUSED:

I understand the contents of this appearance notice and agree to comply with it.

Signed on (date), at (place).

________________

(Signature of accused)

PEACE OFFICER:

Signed on (date), at (place).

________________

(Signature of peace officer)

________________

(Name of the peace officer)
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==Form 10 - Undertaking==
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{{FormHeader1| FORM 10
| (Section 2)
|Undertaking
}}

; 1 Identification

Surname:  __________________________ Given name(s):  __________________________

Date of Birth: ________________

; 2 Contact Information

_________________________

; 3 Charge(s)

(set out briefly the offence in respect of which the accused was charged)

; 4 Mandatory Condition

You must attend court as indicated below, and afterwards as required by the court:

Date:  __________________________

Time:  __________________________

Court number:  __________________________

Court address:  __________________________

5 Additional Conditions

You must also comply with any conditions that are indicated below by a check mark (check only those that are reasonable in the circumstances of the offence and necessary, to ensure the accused’s attendance in court or the safety and security of any victim of or witness to the offence, or to prevent the continuation or repetition of the offence or the commission of another offence):

:{{box}} (a) You must report to (name or title) at (place) on (date or dates).
:{{box}} (b) You must remain within the following territorial jurisdiction: __________________________
:{{box}} (c) You must notify (name, title and phone number) of any change of your (address, employment or occupation).
:□ (d) You must not communicate, directly or indirectly, with ________________, except in accordance with the following conditions: ________________
:□ (e) You must not go to (places which are related to the person(s) mentioned in the condition set out in paragraph (d)), except in accordance with the following conditions: ________________
:□ (f) You must not enter the areas (describe in detail the boundaries of the areas related to the person(s) mentioned in the condition set out in paragraph (d)), except in accordance with the following conditions: ________________
:□ (g) You must deposit all your passports with (name or title) at (place) before (date).
:□ (h) You must reside at (place), be at that residence between (hour) and (hour), and present yourself at the entrance of that residence when a peace officer or (name and title of another person) requests you to do so within those hours.
:□ (i) You must not possess a firearm, cross-bow, prohibited weapon, restricted weapon, prohibited device, ammunition, prohibited ammunition or explosive substance and you must surrender those that are in your possession and also any authorization, licence or registration certificate or other document enabling you to acquire or possess them to (name or title) at (place).
:□ (j) You promise to pay the amount of ________________ (not more than $500), if you fail to comply with a condition of this undertaking.
:□ (k) You must deposit money or other valuable security whose value is equal to the amount of ________________ (not more than $500) with (name or title), because you are not ordinarily resident in the province or do not reside within 200 km of the place in which you are in custody.
:□ (l) You must comply with the following conditions (conditions for ensuring the safety and security of any victim of or witness to the alleged offence): ________________

6 Appearance for the purposes of the Identification of Criminals Act
:□ You are required to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act.

7 Variation and Replacement

The conditions of this undertaking may be varied with the written consent of the prosecutor and yourself. In addition, you or the prosecutor may apply to a justice of the peace to replace this undertaking with a release order under section 515 of the Criminal Code.

8 Conditions in effect

The mandatory condition and the conditions indicated by a check mark on this undertaking remain in effect until they are cancelled or changed or until you have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).

9 Consequence for non-compliance

You are warned that, unless you have a lawful excuse, you commit an offence under section 145 of the Criminal Code if you fail to follow any of the conditions set out in this undertaking, including

:(a) to fail to attend court as required;
:(b) to fail to appear as required for the purposes of the Identification of Criminals Act;
:(c) to fail to remain in the territorial jurisdiction specified in section 5 of this undertaking (if applicable).

If you commit an offence under section 145 of the Criminal Code, a warrant for your arrest may be issued (section 512 or 512.2 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

It is not a lawful excuse to an offence under subsection 145(4) of the Criminal Code that this undertaking does not accurately describe the offence that you are alleged to have committed (subsection 145(6) of the Criminal Code).

If you do not comply with this undertaking or are charged with committing an indictable offence after you have been released, this undertaking may be cancelled and, as a result, you may be detained in custody (subsection 524(4) of the Criminal Code).

If you do not comply with this undertaking, the funds or valuable security promised or deposited by you or your surety could be forfeited (subsection 771(2) of the Criminal Code).

10 Signatures

ACCUSED:

I understand the contents of this undertaking and agree to comply with the mandatory condition and the conditions that are indicated by a check mark.

I understand that I do not have to accept the conditions and that, if I do not accept the conditions, I will be brought to a justice for a bail hearing.

Signed on (date), at (place).

________________

(Signature of accused)

PEACE OFFICER:

Signed on (date), at (place).

________________

(Signature of peace officer)

________________

(Name of the peace officer)

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==Form 11 - Release Order==
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{{FormHeader1| FORM 11
| (Section 2)
| Release Order
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; 1 Identification

Surname: ________________ Given name(s): ________________

Date of Birth: ________________

; 2 Contact Information

________________

; 3 Charge(s)

(set out briefly the offence in respect of which the accused was charged)

; 4 Financial Obligations

□ You do not have any financial obligations under this release order.

or

In order for you to be released, the obligations that are indicated below by a check mark must be complied with.

□ You promise to pay the amount of ________________ if you fail to comply with a condition of this release order.

□ You must deposit money in the amount of ________________ or other valuable security whose value does not exceed ________________ with the clerk of the court.

□ The surety (name), born on (date of birth), (promises to pay or deposits) to the court the amount of ________________

; 5 Conditions

You must comply with the conditions that are indicated below by a check mark.

□ You must report to (name or title) at (place) on (date or dates).

□ You must remain within the territorial jurisdiction of (province or territory).

□ You must notify (name, title and phone number) of any change of your (address, employment or occupation).

□ You must not communicate, directly or indirectly, with (victims, witnesses or other persons), except in accordance with the following conditions: ________________

□ You must not go to (place) or enter (geographic area), except in accordance with the following conditions: ________________

□ You must deposit all your passports with (name or title) at (place) before (date).

□ You must not possess a firearm, crossbow, prohibited weapon, restricted weapon, prohibited device, ammunition, prohibited ammunition or explosive substance and you must surrender any of them in your possession and any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm to (name or title) at (place).

□ You must comply with the following conditions (conditions for ensuring the safety and security of any victim of or witness to the alleged offence): ________________

□ You must comply with the following conditions: ________________

6 Variation

The conditions of this release order may be varied with the written consent of the prosecutor, yourself and your sureties, if any. In addition, you or the prosecutor may apply to a judge to have any condition in this release order cancelled or changed.

7 Conditions in effect

The conditions indicated by a check mark on this release order (including any obligations imposed on your sureties) remain in effect until they are cancelled or changed or until you have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).

8 Consequence for non-compliance

You are warned that, unless you have a lawful excuse, you commit an offence under section 145 of the Criminal Code if you fail to follow any of the conditions set out in this release order, including if you fail to attend court as required.

If you commit an offence under section 145 of the Criminal Code, a warrant for your arrest may be issued (sections 512 and 512.3 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

If you do not comply with this release order or are charged with committing an indictable offence after you have been released, this release order may be cancelled and, as a result, you may be detained in custody (subsection 524(4) of the Criminal Code).

If you do not comply with this release order, the money or other valuable security promised or deposited by you or your surety could be forfeited (subsection 771(2) of the Criminal Code).

9 Signatures

SURETY: (if applicable)

I understand my role and my responsibilities under this release order and I agree to act as a surety.

I agree to (promise or deposit) to the court the amount of money described in section 4 of this release order.

□ Surety Declaration is attached (section 515.1 of the Criminal Code).

□ Surety is excepted from providing Surety Declaration (subsection 515.1(2) of the Criminal Code).

Signed on (date), at (place).

________________

(Signature of the surety)

ACCUSED:

I understand the contents of this form and agree to comply with the conditions that are indicated by a check mark.

I understand that I do not have to accept the conditions and that, if I do not accept the conditions, I will be detained.

Signed on (date), at (place).

________________

(Signature of accused)

JUDGE, JUSTICE OR CLERK OF THE COURT:

Signed on (date), at (place).

________________

(Signature of judge, justice or clerk of the court)

________________

(Name of judge or justice who has issued this order)


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==Form 11.1 - Undertaking Given to a Peace Officer or an Officer in Charge==
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{{FormHeader1| FORM 11.1
| (Sections 493, 499 and 503)
| Undertaking Given to a Peace Officer or an Officer in Charge
}}

I, A.B., of ____________, (occupation), understand that it is alleged that I have committed (set out substance of the offence).

In order that I may be released from custody by way of (a promise to appear or a recognizance), I undertake to (insert any conditions that are directed):
:(a) remain within (designated territorial jurisdiction);
:(b) notify (name of peace officer or other person designated) of any change in my address, employment or occupation;
:(c) abstain from communicating, directly or indirectly, with (identification of victim, witness or other person) or from going to (name or description of place) except in accordance with the following conditions: (as the peace officer or other person designated specifies);
:(d) deposit my passport with (name of peace officer or other person designated);
:(e) to abstain from possessing a firearm and to surrender to (name of peace officer or other person designated) any firearm in my possession and any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm;
:(f) report at (state times) to (name of peace officer or other person designated);
:(g) to abstain from
::(i) the consumption of alcohol or other intoxicating substances, or
::(ii) the consumption of drugs except in accordance with a medical prescription; and

(h) comply with any other conditions that the peace officer or officer in charge considers necessary to ensure the safety and security of any victim of or witness to the offence.

I understand that I am not required to give an undertaking to abide by the conditions specified above, but that if I do not, I may be kept in custody and brought before a justice so that the prosecutor may be given a reasonable opportunity to show cause why I should not be released on giving an undertaking without conditions.

I understand that if I give an undertaking to abide by the conditions specified above, then I may apply, at any time before I appear, or when I appear, before a justice pursuant to (a promise to appear or a recognizance entered into before an officer in charge or another peace officer), to have this undertaking vacated or varied and that my application will be considered as if I were before a justice pursuant to section 515 of the Criminal Code.

I also understand that this undertaking remains in effect until it is vacated or varied.

I also understand that failure without lawful excuse to abide by any of the conditions specified above is an offence under subsection 145(5.1) of the Criminal Code.

Subsection 145(5.1) of the Criminal Code states as follows:

“(5.1) Every person who, without lawful excuse, fails to comply with any condition of an undertaking entered into under subsection 499(2) or 503(2.1)

(a) is guilty of an indictable offence and is liable to imprisonment for a term not exceeding two years; or

(b) is guilty of an offence punishable on summary conviction.”

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

(Signature of accused)

{{LegHistory90s|1994, c. 44}}, s. 84; {{LegHistory90s|1997, c. 18}}, s. 115; {{LegHistory90s|1999, c. 25}}, s. 24; {{LegHistory00s|2002, c. 13}}, s. 86(F); {{LegHistory10s|2018, c. 29}}, s. 71.
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==Form 12 - Surety Declaration ==
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{{FormHeader1| FORM 12
| (Section 515.1)
| Surety Declaration
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1 Identification

Surname: ________________ Given name(s): ________________

Date of Birth: ________________

Home address: ________________

Phone number(s): ________________ (primary) ________________ (other)

Other contact information (if any): ________________

Employment or occupation (if any): ________________

Name and contact information for employer (if any): ________________

2 Information about the Accused

Surname: ________________ Given name(s): ________________

Date of Birth: ________________

Court file number: ________________

3 Other information required

Relationship to the accused: ________________

I am acting as a surety in respect of another accused.

□ Yes □ No

If yes, name and date of birth of any other accused: ________________

I have a criminal record or there are outstanding criminal charges against me.

□ Yes □ No

If yes, description of criminal record, if any, and all outstanding criminal charges, specifying offence and year of conviction: ________________

4 Charges against the Accused

I understand that the accused has been charged with (set out briefly the offence in respect of which the accused was charged).

5 Other Outstanding Charges against the Accused

□ I understand that the accused does not have any other outstanding criminal charges.

□ I understand that the accused has also been charged with (set out briefly the offence in respect of which the accused was charged), but this declaration does not apply to those charges.

6 Criminal Record of the Accused

□ I understand that the accused does not have a criminal record.

□ I understand that the accused has a criminal record, which is described below or a copy of which I have attached and initialled.

________________

7 Financial Promise or Deposit

As a surety for the accused, I am willing to (promise or deposit) to the court the amount of ________________

8 Acknowledgment

I understand that failure on the part of the accused to follow any of the conditions in their release order or recognizance could lead to the forfeiture of the amount of money that has been promised or deposited.

I understand that I may, at any time, ask to no longer be a surety by making an application, by bringing the accused to the court in order to be discharged from my obligation (section 767 of the Criminal Code) or by taking and giving the accused into custody (section 768 of the Criminal Code).

I voluntarily make this declaration and it is my free choice to take on the responsibilities of a surety.

9 Signature

Signed on (date), at (place).

________________

(Signature of the surety)

Sworn before me on (date), at (place).

________________

(Signature of the person who is authorized to take or receive statements made under oath, solemn declaration or solemn affirmation)


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==Form 13 - Undertaking by Appellant (Defendant) ==
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{{FormHeader1|FORM 13
|(Sections 816, 832 and 834)
| Undertaking by Appellant (Defendant)
}}

I, A.B., of ____________, (occupation), being the appellant against conviction (or against sentence or against an order or by way of stated case) in respect of the following matter (set out the offence, subject-matter of order or question of law) undertake to appear personally at the sittings of the appeal court at which the appeal is to be heard.

(and where applicable)

I also undertake to (insert any conditions that are directed)
:(a) report at (state times) to (name of peace officer or other person designated);
:(b) remain within (designated territorial jurisdiction);
:(c) notify (name of peace officer or other person designated) of any change in my address, employment or occupation;
:(d) abstain from communicating, directly or indirectly, with (identification of victim, witness or other person) except in accordance with the following conditions: (as the justice or judge specifies);
:(e) deposit my passport (as the justice or judge directs); and
:(f) (any other reasonable conditions).

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

(Signature of appellant)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 13; {{LegHistory90s|1999, c. 25}}, s. 26.
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==Form 14 - Undertaking by Appellant (Prosecutor)==

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{{FormHeader1| FORM 14
| (Section 817)
| Undertaking by Appellant (Prosecutor)
}}

I, A.B., of ____________, (occupation), being the appellant against an order of dismissal (or against sentence) in respect of the following charge (set out the name of the defendant and the offence, subject-matter of order or question of law) undertake to appear personally or by counsel at the sittings of the appeal court at which the appeal is to be heard.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

(Signature of appellant)
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==Form 15 - Warrant To Convey Accused Before Justice of Another Territorial Division==

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{{FormHeader1|FORM 15
|(Section 543)
|Warrant To Convey Accused Before Justice of Another Territorial Division
}}

To the peace officers in the said (territorial division):

Whereas A.B., of ____________ hereinafter called the accused, has been charged that (state place of offence and charge);

And Whereas I have taken the deposition of X.Y. in respect of the said charge;

And Whereas the charge is for an offence committed in the (territorial division);

This is to command you, in Her Majesty’s name, to convey the said A.B., before a justice of the (last mentioned territorial division).

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________
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==Form 16 - Subpoena to a Witness==
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{{FormHeader1|FORM 16
| (Section 699)
| Subpoena to a Witness 
}}

To E.F., of ____________, (occupation);

Whereas A.B. has been charged that (state offence as in the information), and it has been made to appear that you are likely to give material evidence for (the prosecution or the defence);

This is therefore to command you to attend before (set out court or justice), on ____________ the ____________ day of ____________ A.D. ____________, at ____________ o’clock in the ____________ noon at ____________ to give evidence concerning the said charge.*

*Where a witness is required to produce anything, add the following:

and to bring with you anything in your possession or under your control that relates to the said charge, and more particularly the following: (specify any documents, objects or other things required).

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Judge, Justice or Clerk of the court

(Seal, if required)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 16; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184; {{LegHistory90s|1999, c. 5}}, s. 47.
|}


==Form 16.1 - Subpoena to a Witness in Respect of an Offence Referred to in s. 278.2(1) ==
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{{FormHeader1| FORM 16.1
| (Subsections 278.3(5) and 699(7))
| Subpoena to a Witness in the Case of Proceedings in Respect of an Offence Referred to in Subsection 278.2(1) of the Criminal Code
}}

To E.F., of ____________, (occupation);

Whereas A.B. has been charged that (state offence as in the information), and it has been made to appear that you are likely to give material evidence for (the prosecution or the defence);

This is therefore to command you to attend before (set out court or justice), on ____________ the ____________ day of ____________ A.D. ____________, at ____________ o’clock in the ____________ noon at ____________ to give evidence concerning the said charge, and to bring with you anything in your possession or under your control that relates to the said charge, and more particularly the following: (specify any documents, objects or other things required).

; TAKE NOTE
You are only required to bring the things specified above to the court on the date and at the time indicated, and you are not required to provide the things specified to any person or to discuss their contents with any person unless and until ordered by the court to do so.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, it may be subject to a determination by the court in accordance with sections 278.1 to 278.91 of the Criminal Code as to whether and to what extent it should be produced.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, the production of which is governed by sections 278.1 to 278.91 of the Criminal Code, this subpoena must be accompanied by a copy of an application for the production of the record made pursuant to section 278.3 of the Criminal Code, and you will have an opportunity to make submissions to the court concerning the production of the record.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, the production of which is governed by sections 278.1 to 278.91 of the Criminal Code, you are not required to bring it with you until a determination is made in accordance with those sections as to whether and to what extent it should be produced.

As defined in section 278.1 of the Criminal Code, record means any form of record that contains personal information for which there is a reasonable expectation of privacy and includes, without limiting the generality of the foregoing, medical, psychiatric, therapeutic, counselling, education, employment, child welfare, adoption and social services records, personal journals and diaries, and records containing personal information the production or disclosure of which is protected by any other Act of Parliament or a provincial legislature, but does not include records made by persons responsible for the investigation or prosecution of the offence.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

Judge, Clerk of the Court, Provincial Court Judge or Justice

(Seal, if required)

{{LegHistory90s|1997, c. 30}}, s. 3.
|}

==Form 17 - Warrant for Witness==
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{{FormHeader1| FORM 17
| (Sections 698 and 705)
| Warrant for Witness
}}

To the peace officers in the (territorial division):

Whereas A.B. of ____________, has been charged that (state offence as in the information);

And Whereas it has been made to appear that E.F. of ____________, hereinafter called the witness, is likely to give material evidence for (the prosecution or the defence) and that*

*Insert whichever of the following is appropriate:
:(a) the said E.F. will not attend unless compelled to do so;
:(b) the said E.F. is evading service of a subpoena;
:(c) the said E.F. was duly served with a subpoena and has neglected (to attend at the time and place appointed therein or to remain in attendance);
:(d) the said E.F. was bound by a recognizance to attend and give evidence and has neglected (to attend or to remain in attendance).

This is therefore to command you, in Her Majesty’s name, to arrest and bring the witness forthwith before (set out court or justice) to be dealt with in accordance with section 706 of the Criminal Code.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice or Clerk of the Court

(Seal, if required)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 17; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
|}

==Form 18 - Warrant To Arrest an Absconding Witness==
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{{FormHeader1
| FORM 18
| (Section 704)
| Warrant To Arrest an Absconding Witness
}}

To the peace officers in the (territorial division):

Whereas A.B., of ____________, has been charged that (state offence as in the information);

And Whereas I am satisfied by information in writing and under oath that C.D., of ____________, hereinafter called the witness, is bound by recognizance to give evidence on the trial of the accused on the said charge, and that the witness (has absconded or is about to abscond);

This is therefore to command you, in Her Majesty’s name, to arrest the witness and bring him forthwith before (the court, judge, justice or provincial court judge before whom the witness is bound to appear) to be dealt with in accordance with section 706 of the Criminal Code.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 18; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 203.
|}

==Form 19 - Warrant Remanding a Prisoner==

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{{FormHeader1| FORM 19
| (Sections 516 and 537)
| Warrant Remanding a Prisoner
}}

To the peace officers in the (territorial division):

You are hereby commanded forthwith to arrest, if necessary, and convey to the (prison) at ____________ the persons named in the following schedule each of whom has been remanded to the time mentioned in the schedule:

Person charged ____________ Offence ____________ Remanded to

And I hereby command you, the keeper of the said prison, to receive each of the said persons into your custody in the prison and keep him safely until the day when his remand expires and then to have him before me or any other justice at ____________ at ____________ o’clock in the ____________ noon of the said day, there to answer to the charge and to be dealt with according to law, unless you are otherwise ordered before that time.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 19; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
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==Form 20 - Warrant of Committal of Witness for Refusing to Be Sworn or to Give Evidence==
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{{FormHeader1| FORM 20
| (Section 545)
| Warrant of Committal of Witness for Refusing to Be Sworn or to Give Evidence
}}

To the peace officers in the (territorial division):

Whereas A.B. of ________________, in this warrant called the accused, has been charged that (set out offence as in the information);

And whereas E.F. of ________________, in this warrant called the witness, attending before me (or if the signatory is not the justice, before the justice) to give evidence for (the prosecution or the defence) concerning the charge against the accused (refused to be sworn or being duly sworn as a witness refused to answer certain questions concerning the charge that were put to them or refused or failed to produce the following writings, namely ________________or refused to sign their deposition) having been ordered to do so, without offering any just excuse for that refusal or failure;

This is therefore to direct you, in Her Majesty’s name, to arrest, if necessary, and take the witness and convey them safely to the prison at ________________, and there deliver them to the keeper of it, together with the following precept:

You, the keeper, are directed to receive the witness into your custody in the prison and safely keep them there for the term of ________________ days, unless they sooner consent to do what was required of them, and for so doing this is a sufficient warrant.

Dated (date)________________, at ________________(place).

(Signature of justice or clerk of the court)

________________


|}

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==Form 21 - Warrant of Committal on Conviction==

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{{FormHeader1| FORM 21
| (Sections 570 and 806)
| Warrant of Committal on Conviction
}}

To the peace officers in (territorial division) and to the keeper of (prison) at ____________ :

Whereas (name), in this Form called the offender, was, on the ____________ day of ____________ 20____________, convicted by (name of judge and court) of having committed the following offence(s) and it was adjudged that the offender be sentenced as follows:

; Offence

(state offence of which offender was convicted)

; Sentence

(state term of imprisonment for the offence and, in case of imprisonment for default of payment of fine, so indicate together with the amount of it and applicable costs and whether payable immediately or within a time fixed)

; Remarks

(state the amount of time spent in custody before sentencing, the term of imprisonment that would have been imposed before any credit was granted under subsection 719(3) or (3.1), the amount of time credited, if any, and whether the sentence is consecutive or concurrent, and specify consecutive to or concurrent with what other sentence)

:1. ____________	____________	____________
:2. ____________	____________	____________
:3. ____________	____________	____________
:4. ____________	____________	____________

You are hereby commanded, in Her Majesty’s name, to arrest the offender if it is necessary to do so in order to take the offender into custody, and to take and convey him or her safely to (prison) at ____________ and deliver him or her to its keeper, who is hereby commanded to receive the accused into custody and to imprison him or her there for the term(s) of his or her imprisonment, unless, if a term of imprisonment was imposed only in default of payment of a fine or costs, those amounts and the costs and charges of the committal and of conveying the offender to that prison are paid sooner, and this is a sufficient warrant for so doing.

Dated this ____________ day of ____________ 20____________, at ____________ .

Clerk of the Court, Justice, Judge or Provincial Court Judge

R.S., {{LegHistory80s|1985, c. C-46}}, Form 21; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184; {{LegHistory90s|1995, c. 22}}, s. 9; {{LegHistory00s|2009, c. 29}}, s. 4.
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==Form 22 - Warrant of Committal on an Order for the Payment of Money==
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{{FormHeader1|
| FORM 22
| (Section 806)
| Warrant of Committal on an Order for the Payment of Money
}}

To the peace officers in the (territorial division) and to the keeper of the (prison) at ____________:

Whereas A.B., hereinafter called the defendant, was tried on an information alleging that (set out matter of complaint), and it was ordered that (set out the order made), and in default that the defendant be imprisoned in the (prison) at ____________ for a term of ____________;

I hereby command you, in Her Majesty’s name, to arrest, if necessary, and take the defendant and convey him safely to the (prison) at ____________, and deliver him to the keeper thereof, together with the following precept:

I hereby command you, the keeper of the said prison, to receive the defendant into your custody in the said prison and imprison him there for the term of ____________, unless the said amounts and the costs and charges of the committal and of conveying the defendant to the said prison are sooner paid, and for so doing this is a sufficient warrant.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 22; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
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==Form 23 - Warrant of Committal for Failure To Furnish Recognizance To Keep the Peace==
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{{FormHeader1
| FORM 23
| (Sections 810 and 810.1)
| Warrant of Committal for Failure To Furnish Recognizance To Keep the Peace
}}

To the peace officers in the (territorial division) and to the keeper of the (prison) at ____________:

Whereas A.B., hereinafter called the accused, has been ordered to enter into a recognizance to keep the peace and be of good behaviour, and has (refused or failed) to enter into a recognizance accordingly;

You are hereby commanded, in Her Majesty’s name, to arrest, if necessary, and take the accused and convey him safely to the (prison) at ____________ and deliver him to the keeper thereof, together with the following precept:

You, the said keeper, are hereby commanded to receive the accused into your custody in the said prison and imprison him there until he enters into a recognizance as aforesaid or until he is discharged in due course of law.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

Clerk of the Court, Justice or Provincial Court Judge

(Seal, if required)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 23; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, ss. 184, 203; {{LegHistory90s|1993, c. 45}}, s. 12.

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==Form 24 - Warrant of Committal of Witness for Failure To Enter into Recognizance==

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|{{FormHeader1| FORM 24
| (Section 550)
| Warrant of Committal of Witness for Failure To Enter into Recognizance
}}

To the peace officers in the (territorial division) and to the keeper of the (prison) at ____________:

Whereas A.B., hereinafter called the accused, was committed for trial on a charge that (state offence as in the information);

And Whereas E.F., hereinafter called the witness, having appeared as a witness on the preliminary inquiry into the said charge, and being required to enter into a recognizance to appear as a witness on the trial of the accused on the said charge, has (failed or refused) to do so;

This is therefore to command you, in Her Majesty’s name, to arrest, if necessary, and take and safely convey the said witness to the (prison) at ____________ and there deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the witness into your custody in the said prison and keep him there safely until the trial of the accused on the said charge, unless before that time the witness enters into the said recognizance.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 24; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
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==Form 25 - Warrant of Committal for Contempt==
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|{{FormHeader1| FORM 25
| (Section 708)
| Warrant of Committal for Contempt
}}

To the peace officers in the said (territorial division) and to the keeper of the (prison) at ____________:

Whereas E.F. of ____________, hereinafter called the defaulter, was on the ____________ day of ____________ A.D. ____________, at ____________, convicted before ____________ for contempt in that he did not attend before ____________ to give evidence on the trial of a charge that (state offence as in the information) against A.B. of ____________, although (duly subpoenaed or bound by recognizance to appear and give evidence in that behalf, as the case may be) and did not show any sufficient excuse for his default;

And Whereas in and by the said conviction it was adjudged that the defaulter (set out punishment adjudged);

And Whereas the defaulter has not paid the amounts adjudged to be paid; (delete if not applicable)

This is therefore to command you, in Her Majesty’s name, to arrest, if necessary, and take the defaulter and convey him safely to the prison at ____________ and there deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the defaulter into your custody in the said prison and imprison him there* and for so doing this is a sufficient warrant.

*Insert whichever of the following is applicable:
:(a) for the term of ____________;
:(b) for the term of ____________ unless the said sums and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid;
:(c) for the term of ____________ and for the term of (if consecutive so state) unless the said sums and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice or Clerk of the Court

(Seal, if required)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 25; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
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==Form 26 - Warrant of Committal in Default of Payment of Costs of an Appeal==
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{{FormHeader1| FORM 26
| (Section 827)
| Warrant of Committal in Default of Payment of Costs of an Appeal
}}

To the peace officers of (territorial division) and to the keeper of the (prison) at ____________:

Whereas it appears that on the hearing of an appeal before the (set out court) it was adjudged that A.B., of ____________, hereinafter called the defaulter, should pay to the Clerk of the Court the sum of ____________ dollars in respect of costs;

And Whereas the Clerk of the Court has certified that the defaulter has not paid the sum within the time limited therefor;

I do hereby command you, the said peace officers, in Her Majesty’s name, to take the defaulter and safely convey him to the (prison) at ____________ and deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the defaulter into your custody in the said prison and imprison him for the term of ____________, unless the said sum and the costs and charges of the committal and of conveying the defaulter to the said prison are sooner paid, and for so doing this is a sufficient warrant.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________
|}

==Form 27 - Warrant of Committal on Forfeiture of a Recognizance==
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{{FormHeader1| FORM 27
| (Section 773)
| Warrant of Committal on Forfeiture of a Recognizance}}

To the sheriff of (territorial division) and to the keeper of the (prison) at _________:

You are hereby commanded to arrest, if necessary, and take (A.B. and C.D. as the case may be) hereinafter called the defaulters, and to convey them safely to the (prison) at _________ and deliver them to the keeper thereof, together with the following precept:

You, the said keeper, are hereby commanded to receive the defaulters into your custody in the said prison and imprison them for a period of _________ or until satisfaction is made of a judgment debt of _________ dollars due to Her Majesty the Queen in respect of the forfeiture of a recognizance entered into by _________ on the _________ day of _________ A.D. _________.

Dated this _________ day of ____________ A.D. ____________ .

:::::__________________
:::::Clerk of the _________

(Seal)

R.S., {{LegHistory80s|1985, c. C-46}}, Form 27; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
|}

==Form 28 - Endorsement of Warrant==
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|{{FormHeader1| FORM 28
| (Section 528)
| Endorsement of Warrant
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In accordance with the application this day made to me, I authorize the arrest of the accused (or defendant), within the (territorial division).

Dated (date)________________, at ________________(place). ________________

(Signature of justice) ________________


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==Form 29 - Endorsement of Warrant==
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{{FormHeader1| FORM 29
| (Section 507)
| Endorsement of Warrant
}}

Whereas this warrant is issued under section 507, 508 or 512 of the Criminal Code in respect of an offence other than an offence mentioned in section 522 of the Criminal Code, I hereby authorize the release of the accused pursuant to section 499 of that Act.

Dated this ____________ day of ____________ A.D. ____________, at ____________ .

A Justice of the Peace in and for ____________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 29; {{LegHistory90s|1994, c. 44}}, s. 84.
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==Form 30 - Order for Accused to Be Brought Before Justice Prior to Expiration of Remand==

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{{FormHeader1| FORM 30
| (Section 537)
| Order for Accused to Be Brought Before Justice Prior to Expiration of Period of Remand
}}

To the keeper of the (prison) at ________________:

Whereas by warrant dated (date), A.B., in this order called the accused, was committed to your custody and you were required to keep them safely until the (date)________________________________, and then to have them before me or any other justice (or if the signatory is not the justice, any justice) at (place)________________ at ________________________________(hour) to answer to the charge against the accused and to be dealt with according to law unless you should be ordered otherwise before that time;

Now, therefore, you are directed to have the accused before ________________ at (place)________________ at ________________________________(hour) to answer to the charge against them and so they may be dealt with according to law.

Dated (date)________________, at ________________(place).

(Signature of justice or clerk of the court) ________________


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