View source for Criminal Code Forms (Form 1 to 5.3)

{{Seealso|Criminal Code Forms|Criminal Code Forms (Form 6 to 30)|Criminal Code Forms (Form 31 to 54)}}
[[List of Criminal Code Forms]]
==Form 1 - Information To Obtain a Search Warrant==
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{{FormHeader1|FORM 1
|(Sections 320.29 and 487)
|Information To Obtain a Search Warrant
}}

This is the information of A.B., of __________ in the said (territorial division), (occupation), hereinafter called the informant, taken before me.

The informant says that (describe things to be searched for and offence in respect of which search is to be made), and that he believes on reasonable grounds that the said things, or some part of them, are in the (dwelling-house, etc.) of C.D., of __________, in the said (territorial division). (Here add the grounds of belief, whatever they may be.)

Wherefore the informant prays that a search warrant may be granted to search the said (dwelling-house, etc.) for the said things.

Sworn before me this ____________ day of __________, A.D. __________, at __________.

::::::::::::::::::::::::::::::::::(Signature of Informant)

:::::::________________________________
:::::::A Justice of the Peace in and for __________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 1; {{LegHistory10s|2018, c. 21}}, s. 28.

|}

==Form 2 - Information==

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{{FormHeader1|FORM 2
| (Sections 506 and 788)
| Information
}}

This is the information of C.D., of ___________, (occupation), hereinafter called the informant.

The informant says that (if the informant has no personal knowledge state that he believes on reasonable grounds and state the offence).

Sworn before me this ___________ day of ___________, A.D. ___________, at ___________.

:::::::______________________
:::::::(Signature of Informant)

::__________________________________
::A Justice of the Peace in and for ___________

Note: The date of birth of the accused may be mentioned on the information or indictment.

R.S., {{LegHistory80s|1985, c. C-46}}, Form 2; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184.
|}

==Form 3==
* [Repealed, R.S., 1985, c. 27 (1st Supp.), s. 184]

==Form 4 - Heading of Indictment==
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{{FormHeader1|FORM 4
| (Sections 566, 566.1, 580 and 591)
| Heading of Indictment
}}

In the (set out name of the court)
<center>
Her Majesty the Queen

against

(name of accused)
</center>

(Name of accused) stands charged

1 That he (state offence).

2 That he (state offence).

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

<p align=right>
_________________________________________________________________________<br>
(Signature of signing officer, Agent of Attorney General, etc., as the case may be)
</P>

''Note'': The date of birth of the accused may be mentioned on the information or indictment.

R.S., {{LegHistory80s|1985, c. C-46}}, Form 4; R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184; {{LegHistory90s|1999, c. 3}}, s. 58.
|}

==Form 5 - Warrant To Search==
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{{FormHeader1|FORM 5
| (Sections 320.29 and 487)
| Warrant To Search
}}

To the peace officers in the said (territorial division) or to the (named public officers):

'''WHEREAS''' it appears on the oath of A.B., of __________ that there are reasonable grounds for believing that (describe things to be searched for and offence in respect of which search is to be made) are in __________ at __________, hereinafter called the premises;

This is, therefore, to authorize and require you between the hours of (as the justice may direct) to enter into the said premises and to search for the said things and to bring them before me or some other justice.

'''DATED''' this __________ day of __________ A.D. __________, at __________.

________________________________<br>
A Justice of the Peace in and for __________

R.S., {{LegHistory80s|1985, c. C-46}}, Form 5; {{LegHistory90s|1999, c. 5}}, s. 45; {{LegHistory10s|2018, c. 21}}, s. 28.
|}

===Prior to 2018===
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{{FormHeader1|FORM 5
| (Section 487)
| Warrant To Search
}}

To the peace officers in the said (territorial division) or to the (named public officers):

Whereas it appears on the oath of A.B., of  that there are reasonable grounds for believing that (describe things to be searched for and offence in respect of which search is to be made) are in  at , hereinafter called the premises;

This is, therefore, to authorize and require you between the hours of (as the justice may direct) to enter into the said premises and to search for the said things and to bring them before me or some other justice.

Dated this  day of  A.D. , at  .

A Justice of the Peace in and for 

R.S., 1985, c. C-46, Form 5; 1999, c. 5, s. 45.
|}

==Form 5.001 - Preservation Demand==

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{{FormHeader1|FORM 5.001
|(Subsection 487.012(1))
|Preservation Demand
}}

To (name of person), of ____________:

Because I have reasonable grounds to suspect that the computer data specified below is in your possession or control and that that computer data

will assist in the investigation of an offence that has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament),

<center>(or)</center>

will assist in the investigation of an offence that has been committed under (specify the provision of the law of the foreign state) that is being conducted by a person or authority, (name of person or authority), with responsibility in (specify the name of the foreign state) for the investigation of such offences,

you are required to preserve (specify the computer data) that is in your possession or control when you receive this demand until (insert date) unless, before that date, this demand is revoked or a document that contains that data is obtained under a warrant or an order.

This demand is subject to the following conditions:

If you contravene this demand without lawful excuse, you may be subject to a fine.

You are required to destroy the computer data that would not be retained in the ordinary course of business, and any document that is prepared for the purpose of preserving the computer data, in accordance with section 487.0194 of the Criminal Code. If you contravene that provision without lawful excuse, you may be subject to a fine, to imprisonment or to both.

(Signature of peace officer or public officer)

{{LegHistory10s|2014, c. 31}}, s. 26.

|}

==Form 5.002 - Information To Obtain a Preservation Order==
{{seealso|Preservation Demands and Orders}}
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{{FormHeader1|FORM 5.002
| (Subsection 487.013(2))
| Information To Obtain a Preservation Order
}}

This is the information of (name of peace officer or public officer), of ____________ (“the informant”).

The informant says that they have reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) (or has been committed under (specify the provision of the law of the foreign state)) and that (specify the computer data) is in the possession or control of (name of the person) and will assist in the investigation of the offence.

The informant also says that a peace officer or public officer intends to apply or has applied for a warrant or order in connection with the investigation to obtain a document that contains the computer data (and, if applicable, and that (name of person or authority) is conducting the investigation and has responsibility for the investigation of such offences in (insert the name of the foreign state)).

The reasonable grounds are: (including, if applicable, whether a preservation demand was made under section 487.012 of the Criminal Code)

The informant therefore requests that (name of the person) be ordered to preserve (specify the computer data) that is in their possession or control when they receive the order for 90 days after the day on which the order is made.

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

(Signature of informant)

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.

|}

==Form 5.003 - Preservation Order==
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{{FormHeader1|FORM 5.003
| (Subsection 487.013(4))
| Preservation Order
}}

To (name of person), of ____________:

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________,
:(a) that there are reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) (or has been committed under (specify the provision of the law of the foreign state)) and that (specify the computer data) is in your possession or control and will assist in the investigation of the offence; and
:(b) that a peace officer or public officer intends to apply or has applied for a warrant or order to obtain a document that contains the computer data (and, if applicable, and that (name of person or authority) is conducting the investigation and has responsibility for the investigation of such offences in (insert the name of the foreign state));

Therefore, you are required to preserve the specified computer data that is in your possession or control when you receive this order until (insert date) unless, before that date, this order is revoked or a document that contains that data is obtained under a warrant or an order.

This order is subject to the following conditions:

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

You are required to destroy the computer data that would not be retained in the ordinary course of business, and any document that is prepared for the purpose of preserving the computer data, in accordance with section 487.0194 of the Criminal Code. If you contravene that provision without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.

|}

==Form 5.004 - Information to Obtain a Production Order==
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{{FormHeader1|FORM 5.004
|(Subsections 487.014(2), 487.015(2), 487.016(2), 487.017(2) and 487.018(3))
|Information To Obtain a Production Order
}}

This is the information of (name of peace officer or public officer), of __________ (“the informant”).

The informant says that they have reasonable grounds to suspect (or, if the application is for an order under section 487.014 of the Criminal Code, reasonable grounds to believe)
:(a) that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament); and
:(b) (if the application is for an order under section 487.014 of the Criminal Code) that (specify the document or data) is in the possession or control of (name of the person) and will afford evidence respecting the commission of the offence.
<center>(or)</center>
:(b) (if the application is for an order under section 487.015 of the Criminal Code) that the identification of a device or person involved in the transmission of (specify the communication) will assist in the investigation of the offence and that (specify the transmission data) that is in the possession or control of one or more persons whose identity is unknown will enable that identification.
<center>(or)</center>
:(b) (if the application is for an order under section 487.016 of the Criminal Code) that (specify the transmission data) is in the possession or control of (name of the person) and will assist in the investigation of the offence.
<center>(or)</center>
:(b) (if the application is for an order under section 487.017 of the Criminal Code) that (specify the tracking data) is in the possession or control of (name of the person) and will assist in the investigation of the offence.
<center>(or)</center>
:(b) (if the application is for an order under section 487.018 of the Criminal Code) that (specify the data) is in the possession or control of (name of the financial institution, person or entity) and will assist in the investigation of the offence.

The reasonable grounds are:

The informant therefore requests:

(if the application is for an order under section 487.014 of the Criminal Code) that (name of the person) be ordered to produce a document that is a copy of (specify the document) that is in their possession or control when they receive the order (and/or to prepare and produce a document containing (specify the data) that is in their possession or control when they receive the order).

<center>(or)</center>

(if the application is for an order under section 487.015 of the Criminal Code) that a person who is served with the order in accordance with subsection 487.015(4) of the Criminal Code be ordered to prepare and produce a document containing (specify the transmission data) that is in their possession or control when they are served with the order.

<center>(or)</center>

(if the application is for an order under section 487.016 of the Criminal Code) that (name of the person) be ordered to prepare and produce a document containing (specify the transmission data) that is in their possession or control when they receive the order.

<center>(or)</center>

(if the application is for an order under section 487.017 of the Criminal Code) that (name of the person) be ordered to prepare and produce a document containing (specify the tracking data) that is in their possession or control when they receive the order.

<center>(or)</center>

(if the application is for an order under section 487.018 of the Criminal Code) that (name of the financial institution, person or entity) be ordered to prepare and produce a document setting out (specify the data) that is in their possession or control when they receive the order.

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

::::::::::::::::::::::::::::::::________________________
::::::::::::::::::::::::::::::::(Signature of informant)
::::::::::::::::::::::::::::::::________________________________
::::::::::::::::::::::::::::::::(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.
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==Form 5.005 - Production Order for Documents==
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{{FormHeader1|FORM 5.005
|(Subsection 487.014(3))
|Production Order for Documents
}}

To (name of person), of ____________:

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________, that there are reasonable grounds to believe that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) and that (specify the document or data) is in your possession or control and will afford evidence respecting the commission of the offence;

Therefore, you are ordered to

produce a document that is a copy of (specify the document) that is in your possession or control when you receive this order

<center>(and/or)</center>

prepare and produce a document containing (specify the data) that is in your possession or control when you receive this order.

The document must be produced to (name of peace officer or public officer) within (time) at (place) in (form).

This order is subject to the following conditions:
:1.

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.
|}

==Form 5.006 - Production Order to Trace a Communication==
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{{FormHeader1|FORM 5.006
| (Subsection 487.015(3))
| Production Order To Trace a Communication
}}

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________, that there are reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament), that the identification of a device or person involved in the transmission of (specify the communication) will assist in the investigation of the offence and that one or more persons whose identity was unknown when the application was made have possession or control of (specify the transmission data) that will enable that identification;

Therefore, on being served with this order in accordance with subsection 487.015(4) of the Criminal Code, you are ordered to prepare and produce a document containing (specify the transmission data) that is in your possession or control when you are served with this order.

The document must be produced to (name of peace officer or public officer) as soon as feasible at (place) in (form).

This order is subject to the following conditions:

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

Served on (name of person) on (date), at (place).

(Signature of peace officer or public officer)

(Signature of person served)

{{LegHistory10s|2014, c. 31}}, s. 26.
|}

==Form 5.007 - Production Order for Transmission Data or Tracking Data==
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{{FormHeader1|FORM 5.007
| (Subsections 487.016(3) and 487.017(3))
| Production Order for Transmission Data or Tracking Data
}}

To (name of person), of ____________:

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________, that there are reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) and that (if the order is made under section 487.016 of theCriminal Code, specify the transmission data) (or, if the order is made under section 487.017 of the Criminal Code, specify the tracking data) is in your possession or control and will assist in the investigation of the offence;

Therefore, you are ordered to prepare and produce a document containing the data specified that is in your possession or control when you receive this order.

The document must be produced to (name of peace officer or public officer) within (time) at (place) in (form).

This order is subject to the following conditions:

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.

|}

==Form 5.008 - Production Order for Financial Data==

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{{FormHeader1|FORM 5.008
|(Subsection 487.018(4))
| Production Order for Financial Data
}}

To (name of financial institution, person or entity), of ____________:

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________, that there are reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) and that (specify the data) is in your possession or control and will assist in the investigation of the offence;

Therefore, you are ordered to prepare and produce a document setting out (specify the data) that is in your possession or control when you receive this order.

The document must be produced to (name of the peace officer or public officer) within (time) at (place) in (form).

This order is subject to the following conditions:

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.
|}

==Form 5.0081 - Information To Revoke or Vary an Order Under s. 487.013 to 487.018==
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{{FormHeader1|FORM 5.0081
| (Subsection 487.019(3))
| Information To Revoke or Vary an Order Made Under Any of Sections 487.013 to 487.018 of the Criminal Code
}}

This is the information of (name of peace officer or public officer), of ____________ (“the informant”).

The informant says that on or after (insert date) the informant became aware of the following facts that justify the revocation (or variation) of an order made on (insert date) under (specify the provision of the Criminal Code):

____________

The informant therefore requests that the order be revoked (or be varied as follows: ____________).

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

(Signature of informant)

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.
|}

==Form 5.009 - Information to Obtain a Non-Disclosure Order==

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{{FormHeader1|FORM 5.009
|(Subsection 487.0191(2))
|Information To Obtain a Non-Disclosure Order
}}

This is the information of (name of peace officer or public officer), of ____________ (“the informant”).

The informant says that they have reasonable grounds to believe that the disclosure of the existence (or any of the contents or any of the following portion or portions) of (identify the preservation demand made under section 487.012 of the Criminal Code, the preservation order made under section 487.013 of that Act or the production order made under any of sections 487.014 to 487.018 of that Act, as the case may be) during (identify the period) would jeopardize the conduct of the investigation of the offence to which it relates:

(specify portion or portions)

The reasonable grounds are:

The informant therefore requests an order prohibiting (name of the person, financial institution or entity) from disclosing the existence (or any of the contents or any of the specified portion or portions) of the demand (or the order) during a period of (identify the period) after the day on which the order is made.

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

(Signature of informant)

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.
|}

==Form 5.0091 - Non-Disclosure Order==
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{{FormHeader1|FORM 5.0091
|(Subsection 487.0191(3))
|Non-Disclosure Order
}}

To (name of person, financial institution or entity), of ____________:

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ____________, that there are reasonable grounds to believe that the disclosure of the existence (or any of the contents or any of the portion or portions, specified in the information,) of (identify the preservation demand made under section 487.012 of the Criminal Code, the preservation order made under section 487.013 of that Act or the production order made under any of sections 487.014 to 487.018 of that Act, as the case may be) during (identify the period) would jeopardize the conduct of the investigation of the offence to which it relates;

Therefore, you are prohibited from disclosing the existence (or any of the contents or any of the following portion or portions) of the demand (or the order) during a period of (identify the period) after the day on which this order is made.

(specify portion or portions)

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)

{{LegHistory10s|2014, c. 31}}, s. 26.

|}

==Form 5.01 - Information to Obtain a Warrant To Take Bodily Substances for Analysis==

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{{FormHeader1|FORM 5.01
|(Subsection 487.05(1))
|Information To Obtain a Warrant To Take Bodily Substances for Forensic DNA Analysis
}}

This is the information of (name of peace officer), (occupation), of ____________ in the said (territorial division), hereinafter called the informant, taken before me.

The informant says that he or she has reasonable grounds to believe
:(a) that (offence), a designated offence within the meaning of section 487.04 of the Criminal Code, has been committed;
:(b) that a bodily substance has been found
::(i) at the place where the offence was committed,
::(ii) on or within the body of the victim of the offence,
::(iii) on anything worn or carried by the victim at the time when the offence was committed, or
::(iv) on or within the body of any person or thing or at any place associated with the commission of the offence;
:(c) that (name of person) was a party to the offence; and
:(d) that forensic DNA analysis of a bodily substance from (name of person) will provide evidence about whether the bodily substance referred to in paragraph (b) was from that person.

The reasonable grounds are:

The informant therefore requests that a warrant be issued authorizing the taking from (name of person) of the number of samples of bodily substances that are reasonably required for forensic DNA analysis, provided that the person taking the samples is able by virtue of training or experience to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and provided that, if the person taking the samples is not a peace officer, he or she take the samples under the direction of a peace officer.

Sworn to before me this ____________ day of ____________, A.D. ____________, at ____________ .

(Signature of informant)

(Signature of provincial court judge)

{{LegHistory90s|1998, c. 37}}, s. 24.

|}

==Form 5.02 - Warrant Authorizing Taking of Bodily Substances for Analysis==

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{{FormHeader1|FORM 5.02
| (Subsection 487.05(1))
| Warrant Authorizing the Taking of Bodily Substances for Forensic DNA Analysis
}}

To the peace officers in (territorial division):

Whereas it appears on the oath of (name of peace officer) of ____________ in the said (territorial division), that there are reasonable grounds to believe
:(a) that (offence), a designated offence within the meaning of section 487.04 of the Criminal Code, has been committed,
:(b) that a bodily substance has been found
::(i) at the place where the offence was committed,
::(ii) on or within the body of the victim of the offence,
::(iii) on anything worn or carried by the victim at the time when the offence was committed, or
::(iv) on or within the body of any person or thing or at any place associated with the commission of the offence,
:(c) that (name of person) was a party to the offence, and
:(d) that forensic DNA analysis of a bodily substance from (name of person) will provide evidence about whether the bodily substance referred to in paragraph (b) was from that person;

And whereas I am satisfied that it is in the best interests of the administration of justice to issue this warrant;

This is therefore to authorize and require you to take from (name of person) or cause to be taken by a person acting under your direction, the number of samples of bodily substances that are reasonably required for forensic DNA analysis, provided that the person taking the samples is able by virtue of training or experience to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and provided that, if the person taking the samples is not a peace officer, he or she take the samples under the direction of a peace officer. This warrant is subject to the following terms and conditions that I consider advisable to ensure that the taking of the samples is reasonable in the circumstances:

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

(Signature of provincial court judge)

{{LegHistory90s|1998, c. 37}}, s. 24.
|}

==Form 5.03 - Order Authorizing the Taking of Bodily Substances for Analysis ==

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{{FormHeader1|FORM 5.03
| (Subsections 487.051(1) and (2))
| Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis
}}

To the peace officers in (territorial division):

Whereas (name of person) has been convicted under the Criminal Code, discharged under section 730 of that Act or, in the case of a young person, found guilty under the Young Offenders Act, chapter Y-1 of the Revised Statutes of Canada, 1985, or the ''Youth Criminal Justice Act'' of (offence), which, on the day on which the person was sentenced or discharged, was a primary designated offence within the meaning of section 487.04 of the Criminal Code;

Therefore, you are authorized to take or cause to be taken from (name of person) the number of samples of bodily substances that is reasonably required for forensic DNA analysis, provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

This order is subject to the following terms and conditions that the court considers advisable to ensure that the taking of the samples is reasonable in the circumstances:

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

<div style='text-align: right;'>_________________________<br>
(Signature of judge of the court)</div>

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2002, c. 1}}, s. 185; {{LegHistory00s|2005, c. 25}}, s. 12; {{LegHistory00s|2007, c. 22}}, s. 23; 
{{LegHistory10s|2019, c. 25}}, s. 330.

|}

==Form 5.04 - Order Authorizing Taking of Bodily Substances for DNA Analysis==

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{{FormHeader1|FORM 5.04
|(Subsection 487.051(3))
|Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis
}}


To the peace officers in (territorial division):

Whereas (name of person), in this order called the “person”,
:(a) has been found not criminally responsible on account of mental disorder for (offence), which, on the day on which the finding was made, was a primary designated offence within the meaning of section 487.04 of the Criminal Code, or
:(b) has been convicted under the Criminal Code, discharged under section 730 of that Act or, in the case of a young person, found guilty under the Young Offenders Act, chapter Y-1 of the Revised Statutes of Canada, 1985, or the Youth Criminal Justice Act, of, or has been found not criminally responsible on account of mental disorder for, (offence), which, on the day on which the person was sentenced or discharged or the finding was made, was a secondary designated offence within the meaning of section 487.04 of the Criminal Code;

Whereas the person’s criminal record, the nature of the offence, the circumstances surrounding its commission, whether the person was previously found not criminally responsible on account of mental disorder for a designated offence, and the impact that this order would have on the person’s privacy and security have been considered by the court;

And whereas the court is satisfied that it is in the best interests of the administration of justice to make this order;

Therefore, you are authorized to take or cause to be taken from (name of person) the number of samples of bodily substances that is reasonably required for forensic DNA analysis, provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

This order is subject to the following terms and conditions that the court considers advisable to ensure that the taking of the samples is reasonable in the circumstances:

Dated (date)blank line, at blank line(place).

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


{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2002, c. 1}}, s. 186; {{LegHistory00s|2005, c. 25}}, s. 12; {{LegHistory00s|2007, c. 22}}, s. 23; {{LegHistory10s|2012, c. 1}}, s. 38; 
{{LegHistory10s|2014, c. 25}}, s. 32; {{LegHistory10s|2018, c. 16}}, s. 224, c. 21, s. 29;
{{LegHistory10s|2019, c. 25}}, s. 331;
{{LegHistory20s|2022, c. 17}}, s. 56.
|}

==Form 5.041 - Order to Person To Have Bodily Substances Taken for Analysis==

{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
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{{FormHeader1|FORM 5.041
|(Subsections 487.051(4) and 487.055(3.11))
|Order to a Person To Have Bodily Substances Taken for Forensic DNA Analysis
}}

To A.B., of ____________ ,

Whereas an order has been made under section 487.051, or an authorization has been granted under section 487.055, of the Criminal Code, to take from you the number of samples of bodily substances that is reasonably required for forensic DNA analysis;

This is therefore to order you, in Her Majesty’s name, to appear on ___(date)___ , at _____(hour), at (____place), for the purpose of the taking of bodily substances by means of the investigative procedures set out in subsection 487.06(1) of the Criminal Code.

You are warned that failure to appear in accordance with this order may result in a warrant being issued for your arrest under subsection 487.0551(1) of the Criminal Code. You are also warned that failure to appear, without reasonable excuse, is an offence under subsection 487.0552(1) of that Act.

Subsection 487.0551(1) of the Criminal Code states as follows:

:487.0551 (1) If a person fails to appear at the place, day and time set out in an order made under subsection 487.051(4) or 487.055(3.11) or in a summons referred to in subsection 487.055(4) or 487.091(3), a justice of the peace may issue a warrant for their arrest in Form 5.062 to allow samples of bodily substances to be taken.

Subsection 487.0552(1) of the Criminal Code states as follows:

:487.0552 (1) Every person who, without reasonable excuse, fails to comply with an order made under subsection 487.051(4) or 487.055(3.11) of this Act or under subsection 196.14(4) or 196.24(4) of the ''National Defence Act'', or with a summons referred to in subsection 487.055(4) or 487.091(3) of this Act, is guilty of
::(a) an indictable offence and liable to imprisonment for a term of not more than two years; or
::(b) an offence punishable on summary conviction.

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

(Signature of judge of the court)

{{LegHistory00s|2007, c. 22}}, s. 23;
{{LegHistory10s|2019, c. 25}}, s. 332.
|}

==Form 5.05 - Application for Authorization To Take Bodily Substances for Analysis==
{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
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{{FormHeader1|FORM 5.05
| (Subsection 487.055(1))
| Application for an Authorization To Take Bodily Substances for Forensic DNA Analysis
}}

I (name of peace officer), (occupation), of ____________ in (territorial division), apply for an authorization to take bodily substances for forensic DNA analysis. A certificate referred to in paragraph 667(1)(a) of the Criminal Code is filed with this application.

Whereas (name of offender), before June 30, 2000,
:(a) had been declared a dangerous offender under Part XXIV of the Criminal Code,
:(b) had been declared a dangerous offender or a dangerous sexual offender under Part XXI of the Criminal Code, chapter C-34 of the Revised Statutes of Canada, 1970, as it read from time to time before January 1, 1988,
:(c) had been convicted of murder,
:(c.1) had been convicted of attempted murder or conspiracy to commit murder or to cause another person to be murdered and is currently serving a sentence of imprisonment for that offence,
:(d) had been convicted of a sexual offence within the meaning of subsection 487.055(3) of the Criminal Code and is currently serving a sentence of imprisonment for that offence, or
:(e) had been convicted of manslaughter and is currently serving a sentence of imprisonment for that offence;

Therefore, I request that an authorization be granted under subsection 487.055(1) of the Criminal Code to take from (name of offender) the number of samples of bodily substances that is reasonably required for forensic DNA analysis, provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

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

(Signature of applicant)

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2005, c. 25}}, s. 12; {{LegHistory00s|2007, c. 22}}, s. 23.
|}

==Form 5.06 - Authorization To Take Bodily Substances for Analysis==

{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
|
{{FormHeader1| FORM 5.06
| (Subsection 487.055(1))
| Authorization To Take Bodily Substances for Forensic DNA Analysis
}}

To the peace officers in (territorial division):

Whereas (name of peace officer), a peace officer in (territorial division), has applied for an authorization to take the number of samples of bodily substances from (name of offender) that is reasonably required for forensic DNA analysis by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code;

Whereas (name of offender), before June 30, 2000,
:(a) had been declared a dangerous offender under Part XXIV of the Criminal Code,
:(b) had been declared a dangerous offender or a dangerous sexual offender under Part XXI of the Criminal Code, chapter C-34 of the Revised Statutes of Canada, 1970, as it read from time to time before January 1, 1988,
:(c) had been convicted of murder,
:(c.1) had been convicted of attempted murder or conspiracy to commit murder or to cause another person to be murdered and, on the date of the application, was serving a sentence of imprisonment for that offence,
:(d) had been convicted of a sexual offence within the meaning of subsection 487.055(3) of the Criminal Code and, on the date of the application, was serving a sentence of imprisonment for that offence, or
:(e) had been convicted of manslaughter and, on the date of the application, was serving a sentence of imprisonment for that offence;

And whereas I have considered the offender’s criminal record, the nature of the offence, the circumstances surrounding its commission and the impact that this authorization would have on the offender’s privacy and security of the person;

Therefore, you are authorized to take those samples or cause them to be taken from (name of offender), provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

This authorization is subject to the following terms and conditions that I consider advisable to ensure that the taking of the samples is reasonable in the circumstances:

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

(Signature of provincial court judge)

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2005, c. 25}}, s. 12; {{LegHistory00s|2007, c. 22}}, s. 23.
|}

==Form 5.061 - Summons to Person To Have Bodily Substances Taken for Analysis==
{|class="wikitable" style="width:650px; background-color:white; "
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|-
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{{FormHeader1|FORM 5.061
| (Subsections 487.055(4) and 487.091(3))
| Summons to a Person To Have Bodily Substances Taken for Forensic DNA Analysis
}}

To A.B., of ____________ ,

Whereas an authorization has been granted under section 487.055 or 487.091 of the Criminal Code to take from you the number of samples of bodily substances that is reasonably required for forensic DNA analysis;

This is therefore to command you, in Her Majesty’s name, to appear on ____________ , the ____________ day of ____________ , A.D. ____________ , at ____________ o’clock, at ____________ , for the purpose of the taking of bodily substances by means of the investigative procedures set out in subsection 487.06(1) of the Criminal Code. A peace officer, or a person who is acting under a peace officer’s direction, who takes the samples of bodily substances may use as much force as necessary to do so.

You are warned that failure to appear in accordance with this summons may result in a warrant being issued for your arrest under subsection 487.0551(1) of the Criminal Code. You are also warned that failure to appear, without reasonable excuse, is an offence under subsection 487.0552(1) of that Act.

Subsection 487.0551(1) of the Criminal Code states as follows:
:487.0551 (1) If a person fails to appear at the place, day and time set out in an order made under subsection 487.051(4) or 487.055(3.11) or in a summons referred to in subsection 487.055(4) or 487.091(3), a justice of the peace may issue a warrant for their arrest in Form 5.062 to allow samples of bodily substances to be taken.

Subsection 487.0552(1) of the Criminal Code states as follows:
:487.0552 (1) Every person who, without reasonable excuse, fails to comply with an order made under subsection 487.051(4) or 487.055(3.11) of this Act or under subsection 196.14(4) or 196.24(4) of the ''National Defence Act'', or with a summons referred to in subsection 487.055(4) or 487.091(3) of this Act, is guilty of
::(a) an indictable offence and liable to imprisonment for a term of not more than two years; or
::(b) an offence punishable on summary conviction.

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

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

{{LegHistory00s|2007, c. 22}}, s. 23; 
{{LegHistory10s|2019, c. 25}}, s. 333.
|}

==Form 5.062 - Warrant for Arrest==
{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
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{{FormHeader1|FORM 5.062
| (Subsection 487.0551(1))
| Warrant for Arrest
}}

To the peace officers in (territorial division):

This warrant is issued for the arrest of A.B., of ____________ , (occupation), in this warrant called the “offender”.

Whereas the offender failed to appear at the place, day and time set out in an order made under subsection 487.051(4) or 487.055(3.11), or in a summons referred to in subsection 487.055(4) or 487.091(3), of the Criminal Code to submit to the taking of samples of bodily substances;

This is, therefore, to command you, in Her Majesty’s name, to arrest the offender without delay in order to allow the samples of bodily substances to be taken.

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

A Justice of the Peace in and for ____________

{{LegHistory00s|2007, c. 22}}, s. 23.
|}

==Form 5.07 - Report to a Provincial Court Judge or the Court==

{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
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{{FormHeader1|FORM 5.07
|(Subsection 487.057(1))
|Report to a Provincial Court Judge or the Court
}}

[ ] To (name of judge), a judge of the provincial court who issued a warrant under section 487.05 or granted an authorization under section 487.055 or 487.091 of the Criminal Code or to another judge of that court:

[ ] To the court that made an order under section 487.051 of the Criminal Code:

I (name of peace officer), declare that (state here whether the samples were taken under a warrant issued under section 487.05, an order made under section 487.051 or an authorization granted under section 487.055 or 487.091 of the Criminal Code).

I have (state here whether you took the samples yourself or caused them to be taken under your direction) from (name of offender) the number of samples of bodily substances that I believe is reasonably required for forensic DNA analysis, in accordance with (state whether the samples were taken under a warrant issued or an authorization granted by the judge or another judge of the court or an order made by the court).

The samples were taken on the ____________ day of ____________ , A.D. ____________ , at ____________ o’clock.

I (or state the name of the person who took the samples) took the following samples from (name of offender) in accordance with subsection 487.06(1) of the Criminal Code and was able, by virtue of training or experience, to do so (check applicable box):
:[ ] individual hairs, including the root sheath
:[ ] epithelial cells taken by swabbing the lips, tongue or inside cheeks of the mouth
:[ ] blood taken by pricking the skin surface with a sterile lancet

Any terms or conditions in the (warrant, order or authorization) have been complied with.

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

(Signature of peace officer)

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2007, c. 22}}, s. 24.
|}

==Form 5.08 - Application for Authorization To Take Additional Samples of Bodily Substances Analysis ==
{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
|
{{FormHeader1|FORM 5.08
| (Subsection 487.091(1))
| Application for an Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis
}}

I (name of peace officer), (occupation), of ____________ in (territorial division), apply for an authorization to take additional samples of bodily substances for forensic DNA analysis.

Whereas samples of bodily substances were taken from (name of offender) for the purpose of forensic DNA analysis under an order made under section 487.051, or an authorization granted under section 487.055, of the Criminal Code (attach a copy of the order or authorization);

And whereas on (day/month/year) it was determined that
:(a) a DNA profile could not be derived from the samples for the following reasons:
:(b) the information or bodily substances required by regulations made under the ''DNA Identification Act'' were not transmitted in accordance with the requirements of the regulations or were lost for the following reasons:

Therefore, I request that an authorization be granted under subsection 487.091(1) of the Criminal Code to take from (name of offender) the number of additional samples of bodily substances that is reasonably required for forensic DNA analysis, provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

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

(Signature of applicant)

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2005, c. 25}}, s. 13; {{LegHistory00s|2007, c. 22}}, s. 25.
|}

==Form 5.09 - Authorization To Take Additional Samples of Bodily Substances for Analysis==
{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
|
{{FormHeader1
|FORM 5.09
| (Subsection 487.091(1))
| Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis
}}

To the peace officers in (territorial division):

Whereas samples of bodily substances were taken from (name of offender) for the purpose of forensic DNA analysis under an order made under section 487.051 or an authorization granted under section 487.055, of the Criminal Code;

Whereas on (day/month/year) it was determined that
:(a) a DNA profile could not be derived from the samples for the following reasons:
:(b) the information or bodily substances required by regulations made under the ''DNA Identification Act'' were not transmitted in accordance with the requirements of the regulations or were lost for the following reasons:

And whereas (name of peace officer), a peace officer in (territorial division), has applied for an authorization to take the number of additional samples of bodily substances from (name of offender) that is reasonably required for forensic DNA analysis by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code;

Therefore, you are authorized to take those additional samples, or cause them to be taken, from (name of offender), provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

This authorization is subject to the following terms and conditions that I consider advisable to ensure that the taking of the samples is reasonable in the circumstances:

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

(Signature of provincial court judge)

{{LegHistory90s|1998, c. 37}}, s. 24; {{LegHistory00s|2005, c. 25}}, s. 13; {{LegHistory00s|2007, c. 22}}, s. 25.
|}

==Form 5.1 - Warrant To Search==
{{seealso|Section 487 Search Warrants}}
{|class="wikitable" style="width:650px; background-color:white; "
!Copy/Paste
|-
|
{{FormHeader1|FORM 5.1
| (Sections 320.29 and 487.1)
| Warrant To Search
}}


To A.B. and other peace officers in the [territorial division in which the warrant is intended for execution]:

Whereas it appears on the oath of A.B., a peace officer in the [territorial division in which the warrant is intended for execution], that there are reasonable grounds for dispensing with an information presented personally and in writing; and that there are reasonable grounds for believing that the following things

::[describe things to be searched for]

relevant to the investigation of the following indictable offence

::[describe offence in respect of which search is to be made]

are to be found in the following place or premises

[describe place or premises to be searched]:

This is, therefore, to authorize you to enter the said place or premises between the hours of [as the justice may direct] and to search for and seize the said things and to report thereon as soon as practicable but within a period not exceeding seven days after the execution of the warrant to the clerk of the court for the [territorial division in which the warrant is intended for execution].

Issued at [time] on the [day] of [month] A.D. [year], at [place].
::::::::::_____________________________________________________________________________
::::::::::A Judge of the Provincial Court in and for the Province of [specify province].

To the Occupant: This search warrant was issued by telephone or other means of telecommunication. If you wish to know the basis on which this warrant was issued, you may apply to the clerk of the court for the territorial division in which the warrant was executed, at [address], to obtain a copy of the information on oath.

You may obtain from the clerk of the court a copy of the report filed by the peace officer who executed this warrant. That report will indicate the things, if any, that were seized and the location where they are being held.

R.S., 1985, c. 27 (1st Supp.), s. 184, c. 1 (4th Supp.), s. 17;
{{LegHistory10s|2018, c. 21}}, s. 30

|}

==Form 5.2 - Report to a Justice==
{|class="wikitable" style="width:650px; background-color:white; "
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|-
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{{FormHeader1|FORM 5.2
| (Section 489.1)
| Report to a Justice
}}

To the justice who issued a warrant to the undersigned under section 320.29, 487 or 487.1 of the Criminal Code (or another justice for the same territorial division or, if no warrant was issued, any justice having jurisdiction in respect of the matter).

I, (name of the peace officer or other person) have (state here whether you have acted under a warrant issued under section 320.29, 487 or 487.1 of theCriminal Codeor under section 489 of theCriminal Codeor otherwise in the execution of duties under theCriminal Codeor other Act of Parliament to be specified)

:1 searched the premises situated at ____________; and

:2 seized the following things and dealt with them as follows:

{|
|Property Seized<br>
(describe each thing seized)
|
Disposition<br>
(state, in respect of each thing seized, whether
:(a) it was returned to the person lawfully entitled to its possession, in which case the receipt for it shall be attached to this report; or
:(b) it is being detained to be dealt with according to law, in which case indicate the location and manner in which or, if applicable, the person by whom, it is being detained.)
|-
|
1. ____________	____________<br>
2. ____________	____________<br>
3. ____________	____________<br>
4. ____________	____________<br>
|
|}

In the case of a warrant issued by telephone or other means of telecommunication, the statements referred to in subsection 487.1(9) of the Criminal Code shall be specified in the report.

Dated (date), at (place).

_________________________<br>
Signature of the peace officer or other person

R.S., {{LegHistory80s|1985, c. 27 (1st Supp.)}}, s. 184; {{LegHistory10s|2018, c. 21}}, s. 31.



|}

; See Also
* [https://www.courts.ns.ca/Provincial_Court/NSPC_forms/50-5.2-InitialReportJudge-June-02.pdf NS template]

==Form 5.3 - Report to a Judge of Property Seized==
{|class="wikitable" style="width:650px; background-color:white; "
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{{FormHeader1|FORM 5.3| (Section 462.32)| Report to a Judge of Property Seized}}

To a judge of the court from which the warrant was issued (specify court):

I, (name of the peace officer or other person) have acted under a warrant issued under section 462.32 of the Criminal Code and have

1 searched the premises situated at ____________; and

2 seized the following property:

Property Seized

(describe each item of property seized)

Location

(state, in respect of each item of property seized, the location where it is being detained).

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

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

___________________________________<Br>
Signature of peace officer or other person

R.S., 1985, c. 42 (4th Supp.), s. 6.
|}