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==Form 48.1 - Assessment Order of the Review Board
==Form 48.1 - Assessment Order of the Review Board ==
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==Form 48.2==
==Form 48.2 - Victim Impact Statement — Not Criminally Responsible==


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Revision as of 20:24, 16 April 2021

See also: List of Criminal Code Forms and Precedents, Court Forms and Checklists

List

Form Title Related Section Amendments Related Articles
Form 1 Information to Obtain a Search Warrant s. 487 [Section 487 Search Warrants] N/A Section 487 Search Warrants
Form 2 Information s. 506 [Laying of an Information] and 788 [Laying an Summary Offence Information] R.S., 1985, c. C-46, Form 2;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Informations and Indictments
Form 4 Heading of Indictment s. 566 [Preferring indictments], 566.1 [Indictments, Nunavut], 580 [Form of indictment] and 591 [Joinder and severance] R.S., 1985, c. C-46, Form 4;
R.S., 1985, c. 27 (1st Supp.), s. 184;
1999, c. 3, s. 58. 		Informations and Indictments
Form 5 Warrant to Search s. 487 R.S., 1985, c. C-46, Form 5;
1999, c. 5, s. 45. 		Section 487 Search Warrants
Form 5.001 Preservation Demand s. 487.012(1) 2014, c. 31, s. 26. Preservation Demands and Orders
Form 5.002 Information To Obtain a Preservation Demand s. 487.013(2) 2014, c. 31, s. 26. Preservation Demands and Orders
Form 5.003 Preservation Order s. 487.013(4) 2014, c. 31, s. 26. Preservation Demands and Orders
Form 5.004 Information To Obtain a Production Order s. 487.014(2), 487.015(2), 487.016(2), 487.017(2) and 487.018(3) 2014, c. 31, s. 26.
Form 5.005 Production Order for Documents s. 487.014(3) 2014, c. 31, s. 26.
Form 5.006 Production Order To Trace a Communication s. 487.015(3) 2014, c. 31, s. 26. Trace Specified Communications Production Orders
Form 5.007 Production Order for Transmission Data or Tracking Data s. 487.016(3) and 487.017(3) 2014, c. 31, s. 26. Transmission Data Production Orders
Production Orders for Tracking Data
Form 5.008 Production Order for Financial Data s. 487.018(4) 2014, c. 31, s. 26. Production Orders for Financial Data
Form 5.0081 Information To Revoke or Vary an Order Made Under Any of Sections 487.013 to 487.018 of the Criminal Code s. 487.019(3) 2014, c. 31, s. 26. Production Orders
Form 5.009 Information To Obtain a Non-Disclosure Order s. 487.0191(2) 2014, c. 31, s. 26. Sealing and Unsealing Judicial Authorizations
FORM 5.0091 Non-Disclosure Order s. 487.0191(3) 2014, c. 31, s. 26. Sealing and Unsealing Judicial Authorizations
Form 5.01 Information To Obtain a Warrant To Take Bodily Substances for Forensic DNA Analysis s. 487.05(1) 1998, c. 37, s. 24. Section 487.05 Seizure Warrant of DNA Samples
Form 5.02 Warrant Authorizing the Taking of Bodily Substances for Forensic DNA Analysis s. 487.05(1) 1998, c. 37, s. 24. Section 487.05 Seizure Warrant of DNA Samples
Form 5.03 Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis s. 487.051(1) and (2) 1998, c. 37, s. 24;
2002, c. 1, s. 185;
2005, c. 25, s. 12;
2007, c. 22, s. 23. 		DNA Orders (Primary Designated Offences)
Form 5.04 Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis s. 487.051(3) [persons found not criminally responsible and secondary designated offences] 1998, c. 37, s. 24;
2002, c. 1, s. 186;
2005, c. 25, s. 12;
2007, c. 22, s. 23;
2012, c. 1, s. 38;
2014, c. 25, s. 32. 		DNA Orders (secondary designated offences)
Form 5.041 Order to a Person To Have Bodily Substances Taken for Forensic DNA Analysis s. 487.051(4) and 487.055(3.11) 2007, c. 22, s. 23. DNA Orders (Primary Designated Offences)
Form 5.05 Application for an Authorization To Take Bodily Substances for Forensic DNA Analysis s. 487.055(1) 1998, c. 37, s. 24;
2005, c. 25, s. 12;
2007, c. 22, s. 23. 		Miscellaneous DNA Provisions
Form 5.06 Authorization To Take Bodily Substances for Forensic DNA Analysis s. 487.055(1) 1998, c. 37, s. 24;
2005, c. 25, s. 12;
2007, c. 22, s. 23. 		Persons failing to Attend for Taking of Sample
Form 5.061 Summons to a Person To Have Bodily Substances Taken for Forensic DNA Analysis s. 487.055(4) and 487.091(3) 2007, c. 22, s. 23. Miscellaneous DNA Provisions
Section 487.05 Seizure Warrant of DNA Samples
Form 5.062 Warrant for Arrest s. 487.0551(1) 2007, c. 22, s. 23. Persons failing to Attend for Taking of Sample
Form 5.07 Report to a Provincial Court Judge or the Court s. 487.057(1) 1998, c. 37, s. 24;
2007, c. 22, s. 24. 		DNA Orders
Form 5.08 Application for an Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis s. 487.091(1) 1998, c. 37, s. 24;
2005, c. 25, s. 13;
2007, c. 22, s. 25. 		Section 487.05 Seizure Warrant of DNA Samples
Form 5.09 Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis s. 487.091(1) 1998, c. 37, s. 24;
2005, c. 25, s. 13;
2007, c. 22, s. 25. 		Section 487.05 Seizure Warrant of DNA Samples
Form 5.1 Warrant To Search s. 487.1 R.S., 1985, c. 27 (1st Supp.), s. 184, c. 1 (4th Supp.), s. 17.
Form 5.2 Report to a Justice s. 489.1 [Restitution of property or report by peace officer] R.S., 1985, c. 27 (1st Supp.), s. 184. Procedure on Seizure of Property
Form 5.3 Report to a Judge of Property Seized s. 462.32 R.S., 1985, c. 42 (4th Supp.), s. 6. Proceeds of Crime Search Warrant
Form 6 Summons to a Person Charged with an Offence s. 493, 508, and 512 R.S., 1985, c. C-46, Form 6;
R.S., 1985, c. 27 (1st Supp.), s.184. 		Issuing Process
Form 7 Warrant for Arrest s. 475, 493, 597, 800 and 803 R.S., 1985, c. C-46, Form 7;
R.S., 1985, c. 27 (1st Supp.), s.203;
1997, c. 39, s. 3;
1999, c. 5, s. 46.
Form 7.1 Warrant To Enter Dwelling-house s. 529.1 [Entry into Place to Execute an Arrest Warrant] 1997, c. 39, s. 3;
2002, c. 13, s. 85. 		Entry into Place to Execute an Arrest Warrant
Form 8 Warrant for Committal s. 493 and 515 R.S., 1985, c. C-46, Form 8;
R.S., 1985, c. 27 (1st Supp.), ss. 184, 203. 		Continued Detention After Appearing Before a Justice
Form 9 Appearance Notice Issued by a Peace Officer to a Person Not Yet Charged with an Offence s. 493 R.S., 1985, c. C-46, Form 9;
R.S., 1985, c. 27 (1st Supp.), s. 184;
1994, c. 44, s. 84;
1997, c. 18, s. 115.
Form 10 Promise to Appear s. 493 R.S., 1985, c. C-46, Form 10;
1994, c. 44, s. 84;
1997, c. 18, s. 115. 		Promise to Appear, Issued by Police
Form 11 Recognizance Entered into Before an Officer in Charge or Other Peace Officer s. 493 [Definitions of "recognizance" and "officer in charge"] R.S., 1985, c. C-46, Form 11;
1992, c. 1, s. 58;
1994, c. 44, s. 84;
1997, c. 18, s. 115. 		Release by Police
Form 11.1 Undertaking Given to a Peace Officer or an Officer in Charge s. 493, 499, and 503 1994, c. 44, s. 84;
1997, c. 18, s. 115;
1999, c. 25, s. 24;
2002, c. 13, s. 86(F). 		Release by Police
Form 12 Undertaking Given to a Justice or a Judge s. 493 and 679 R.S., 1985, c. C-46, Form 12;
R.S., 1985, c. 27 (1st Supp.), s. 184;
1994, c. 44, s. 84;
1999, c. 25, s. 25;
2008, c. 18, s. 45.1. 		Release With and Without Sureties and Deposits
Form 13 Undertaking by Appellant (Defendant) s. 816, 832, and 834 R.S., 1985, c. C-46, Form 13;
1999, c. 25, s. 26. 		Bail Pending Appeal
Form 14 Undertaking by Appellant (Prosecutor) s. 817 N/A Bail Pending Appeal
Form 15 Warrant To Convey Accused Before Justice of Another Territorial Division s. 543 N/A
Form 16 Subpoena to a Witness s. 699 R.S., 1985, c. C-46, Form 16;
R.S., 1985, c. 27 (1st Supp.), s. 184;
1999, c. 5, s. 47. 		Compelling Attendance of Witnesses
Form 16.1 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 s. 278.3(5) [Service of application and subpoena] and 699(7) [Form of subpoena in sexual offences] 1997, c. 30, s. 3. Production of Records for Sexual Offences
Compelling Attendance of Witnesses
Form 17 Warrant for Witness s. 698 and 705 R.S., 1985, c. C-46, Form 17;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Arrest Warrants for Witnesses
Form 18 Warrant To Arrest an Absconding Witness s. 704 R.S., 1985, c. C-46, Form 18;
R.S., 1985, c. 27 (1st Supp.), s. 203. 		Arrest Warrants for Witnesses
Form 19 Warrant Remanding a Prisoner s. 516 and 537 R.S., 1985, c. C-46, Form 19;
R.S., 1985, c. 27 (1st Supp.), s. 184.
Form 20 Warrant of Committal of Witness for Refusing To Be Sworn or To Give Evidence s. 545 R.S., 1985, c. C-46, Form 20;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Witness Refusing to Testify
Form 21 Warrant of Committal on Conviction s. 570 and 806 R.S., 1985, c. C-46, Form 21;
R.S., 1985, c. 27 (1st Supp.), s. 184;
1995, c. 22, s. 9;
2009, c. 29, s. 4.
Form 22 Warrant of Committal on an Order for the Payment of Money s. 806 R.S., 1985, c. C-46, Form 22;
R.S., 1985, c. 27 (1st Supp.), s. 184.
Form 23 Warrant of Committal for Failure To Furnish Recognizance To Keep the Peace s. 810 and 810.1 R.S., 1985, c. C-46, Form 23;
R.S., 1985, c. 27 (1st Supp.), ss. 184, 203;
1993, c. 45, s. 12.
Form 24 Warrant of Committal of Witness for Failure To Enter into Recognizance s. 550 R.S., 1985, c. C-46, Form 24;
R.S., 1985, c. 27 (1st Supp.), s. 184.
Form 25 Warrant of Committal for Contempt s. 708 [Contempt] R.S., 1985, c. C-46, Form 25;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Finding of Contempt
Form 26 Warrant of Committal in Default of Payment of Costs of an Appeal s. 827 N/A
Form 27 Warrant of Committal on Forfeiture of a Recognizance s. 773 R.S., 1985, c. C-46, Form 27;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Estreatment of Recognizance
Form 28 Endorsement of Warrant s. 487 and 528 R.S., 1985, c. C-46, Form 28;
R.S., 1985, c. 27 (1st Supp.), s. 184.
Form 28.1 Repealed Repealed N/A
Form 29 Endorsement of Warrant s. 507 R.S., 1985, c. C-46, Form 29;
1994, c. 44, s. 84. 		Issuing Process
Form 30 Order for Accused To Be Brought Before Justice Prior to Expiration of Period of Remand s. 537 N/A
Form 31 Deposition of a Witness s. 540 N/A Preliminary Inquiry Depositions
Form 32 Recognizance s. 493, 550, 679, 706, 707, 810, 810.1 and 817 R.S., 1985, c. C-46, Form 32;
R.S., 1985, c. 27 (1st Supp.), ss. 101, 184, 203;
c. 42 (4th Supp.), s. 7;
1993, c. 45, ss. 13, 14;
1999, c. 25, s. 27. 		Release With and Without Sureties and Deposits
Form 33 Certificate of Default To Be Endorsed on Recognizance s. 770 R.S., 1985, c. C-46, Form 33;
R.S., 1985, c. 27 (1st Supp.), s. 203;
1994, c. 44, s. 84.
Form 34 Writ of Fieri Facias s. 771 N/A Estreatment of Recognizance
Form 34.1 Statement on Restitution s. 737.1(4) 2011, c. 6, s. 5;
2015, c. 13, s. 35. 		Restitution
Form 34.2 Victim Impact Statement s. 722(4) 2015, c. 13, s. 35. Victim Impact Statements
Form 34.3 Community Impact Statement s. 722.2(2) 2015, c. 13, s. 35. Victim Impact Statements
Form 35 Conviction s. 570 and 806 R.S., 1985, c. C-46, Form 35;
R.S., 1985, c. 27 (1st Supp.), ss. 184, 203. 		Trial Verdicts
Form 36 Order Against an Offender s. 570 and 806 R.S., 1985, c. C-46, Form 36;
R.S., 1985, c. 27 (1st Supp.), s. 184. 		Trial Verdicts
Form 37 Order Acquitting Accused s. 570 R.S., 1985, c. C-46, Form 37;
R.S., 1985, c. 27 (1st Supp.), ss. 184, 203. 		Trial Verdicts
Form 38 Conviction for Contempt s. 708 N/A Contempt of Court (Offence)
Form 39 Order for Discharge of a Person in Custody s. 519 and 550 N/A
Form 40 Challenge To Array s. 629 N/A Challenge to Jury Panel
Form 41 Challenge for Cause s. 639 N/A Challenge for Cause
Form 42 Certificate of Non-payment of Costs of Appeal s. 827 N/A Appeal Procedure For Summary Convictions
Form 43 Jailer’s Receipt to Peace Officer for Prisoner s. 744 R.S., 1985, c. C-46, Form 43;
1995, c. 22, s. 18. 		Imprisonment, Execution of Warrant of Committal
Form 44 N/A s. 667 [Proof of previous conviction] R.S., 1985, c. C-46, Form 44;
R.S., 1985, c. 27 (1st Supp.), s. 184, c. 1 (4th Supp.), s. 18;
1995, c. 22, s. 18;
2005, c. 10, s. 34. 		Proof of Previous Conviction
Form 45 N/A s. 667 R.S., 1985, c. C-46, Form 45;
R.S., 1985, c. 27 (1st Supp.), s. 184;
2005, c. 10, s. 34. 		Proof of Previous Conviction
Form 46 Probation Order s. 732.1 R.S., 1985, c. C-46, Form 46;
R.S., 1985, c. 27 (1st Supp.), s. 203;
1995, c. 22, s. 10;
2004, c. 12, s. 17. 		Probation Orders
Form 47 Order To Disclose Income Tax Information s. 462.48 R.S., 1985, c. 42 (4th Supp.), s. 8. Proceeds of Crime Disclosure Order
Form 48 Assessment Order of the Court s. 672.13 1991, c. 43, s. 8;
1995, c. 22, s. 10;
2005, c. 22, s. 40;
2014, c. 6, s. 19. 		Assessment for Fitness and Criminal Responsibility
Form 48.1 Assessment Order of the Review Board s. 672.13 2005, c. 22, s. 40;
2014, c. 6, s. 20. 		Assessment for Fitness and Criminal Responsibility
Form 48.2 Victim Impact Statement — Not Criminally Responsible s. 672.5(14) 2015, c. 13, s. 36. Review Board Hearing Procedure
Form 49 Warrant of Committal, Disposition of Detention s. 672.57 1991, c. 43, s. 8. Review Board Disposition Hearings
Form 50 Warrant of Committal, Placement Decision s. 672.7(2) [Warrant of committal, Review Board] 1991, c. 43, s. 8. Dual Status Offenders
Form 51 Notice of Obligation To Provide Samples of Bodily Substance s. 732.1(3)(c.2), 742.3(2)(a.2), 810(3.02)(c), 810.01(4.1)(g), 810.011(6)(f), 810.1(3.02)(i) and 810.2(4.1)(g) 1991, c. 43, s. 8;
1995, c. 22, s. 10 (Sch. I, item 37);
2005, c. 22, s. 41;
2011, c. 7, s. 13;
2015, c. 20, s. 34.
Form 52 Order To Comply with Sex Offender Information Registration Act s. 490.012 2004, c. 10, s. 21;
2007, c. 5, s. 30;
2010, c. 17, s. 26;
2013, c. 24, s. 117(F). 		SOIRA Orders
Form 53 Notice of Obligation To Comply with Sex Offender Information Registration Act s. 490.019 and 490.032 2004, c. 10, s. 21;
2007, c. 5, s. 31;
2013, c. 24, s. 117(F);
2014, c. 25, s. 33. 		SOIRA Orders
Form 54 Obligation To Comply with Sex Offender Information Registration Act s. 490.02901 to 490.02903, 490.02905 and 490.032 2010, c. 17, s. 27. SOIRA Orders

Form 1 - Information To Obtain a Search Warrant

Copy/Paste
FORM 1
(Sections 320.29 and 487)
Information To Obtain a Search Warrant

Canada,

Province of __________,

(territorial division).

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., 1985, c. C-46, Form 1; 2018, c. 21, s. 28.

Form 2 - Information

Copy/Paste
FORM 2
(Sections 506 and 788)
Information

Canada,

Province of ___________,

(territorial division).

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

Form 3

  • Repealed

Form 4 - Heading of Indictment

Copy/Paste
FORM 4
(Sections 566, 566.1, 580 and 591)
Heading of Indictment
Canada,
Province of __________,
(territorial division).

In the (set out name of the court)

Her Majesty the Queen

against

(name of accused)

(Name of accused) stands charged

1 That he (state offence).

2 That he (state offence).

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

_________________________________________________________________________
(Signature of signing officer, Agent of Attorney General, etc., as the case may be)

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

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

Form 5 - Warrant to Search

Copy/Paste
FORM 5
(Sections 320.29 and 487)
Warrant To Search

Canada,

Province of __________,

(territorial division).

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; 2018, c. 21, s. 28.

Prior to 2018

FORM 5
(Section 487)
Warrant To Search
Canada,

Province of ,

(territorial division).

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

Copy/Paste
FORM 5.001
(Subsection 487.012(1))
Preservation Demand
Canada,
Province of ____________

(territorial division)

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),

(or)

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)

2014, c. 31, s. 26.

Form 5.002 - Information To Obtain a Preservation Order

Copy/Paste
FORM 5.002
(Subsection 487.013(2))
Information To Obtain a Preservation Order
Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.003 - Preservation Order

Copy/Paste
FORM 5.003
(Subsection 487.013(4))
Preservation Order
Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.004 - Information To Obtain a Production Order

Copy/Paste
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
Canada,

Province of __________

(territorial division)

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.
(or)
(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.
(or)
(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.
(or)
(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.
(or)
(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).

(or)

(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.

(or)

(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.

(or)

(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.

(or)

(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)

2014, c. 31, s. 26.

Form 5.005 - Production Order for Documents

Copy/Paste
FORM 5.005
(Subsection 487.014(3))
Production Order for Documents
Canada,

Province of ____________

(territorial division)

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

(and/or)

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)

2014, c. 31, s. 26.

Form 5.006 - Production Order To Trace a Communication

Copy/Paste
FORM 5.006
(Subsection 487.015(3))
Production Order To Trace a Communication
Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.007 - Production Order for Transmission Data or Tracking Data

Copy/Paste
FORM 5.007
(Subsections 487.016(3) and 487.017(3))
Production Order for Transmission Data or Tracking Data
Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.008 - Production Order for Financial Data

Copy/Paste
FORM 5.008
(Subsection 487.018(4))
Production Order for Financial Data

Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.0081 - Information To Revoke or Vary an Order Under s. 487.013 to 487.018

Copy/Paste
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

Canada,

Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.009 - Information To Obtain a Non-Disclosure Order

Copy/Paste
FORM 5.009
(Subsection 487.0191(2))
Information To Obtain a Non-Disclosure Order
Canada,
Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

Form 5.0091 - Non-Disclosure Order

Copy/Paste
FORM 5.0091
(Subsection 487.0191(3))
Non-Disclosure Order
Canada,
Province of ____________

(territorial division)

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)

2014, c. 31, s. 26.

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

Copy/Paste
FORM 5.01
(Subsection 487.05(1))
Information To Obtain a Warrant To Take Bodily Substances for Forensic DNA Analysis
Canada,
Province of ____________

(territorial division)

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)

1998, c. 37, s. 24.

Form 5.02 - Warrant Authorizing Taking of Bodily Substances for Analysis

Copy/Paste
FORM 5.02
(Subsection 487.05(1))
Warrant Authorizing the Taking of Bodily Substances for Forensic DNA Analysis
Canada,

Province of ____________

(territorial division)

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)

1998, c. 37, s. 24.

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

Copy/Paste
FORM 5.03
(Subsections 487.051(1) and (2))
Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis

Canada

Province of ____________

(territorial division)

To the peace officers in (territorial division):

Whereas (name of offender) 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 offender 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 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.

This order 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 judge of the court)

1998, c. 37, s. 24; 2002, c. 1, s. 185; 2005, c. 25, s. 12; 2007, c. 22, s. 23.

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

Copy/Paste
FORM 5.04
(Subsection 487.051(3))
Order Authorizing the Taking of Bodily Substances for Forensic DNA Analysis
Canada
Province of ____________

(territorial division)

To the peace officers in (territorial division):

Whereas (name of offender), in this order called the “offender”,

(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 offender was sentenced or discharged or the finding was made, was one of the following secondary designated offences within the meaning of section 487.04 of the Criminal Code (check applicable box):

[ ] (i) an offence under the Criminal Code for which the maximum punishment is imprisonment for five years or more and that was prosecuted by indictment,

[ ] (i.01) an offence under any of sections 9 to 14 of the Cannabis Act for which the maximum punishment is imprisonment for five years or more and that was prosecuted by indictment,

[ ] (ii) an offence under any of sections 5 to 7 of the Controlled Drugs and Substances Act for which the maximum punishment is imprisonment for five years or more and that was prosecuted by indictment,

[ ] (iii) an offence under any of sections 145 to 148, subsection 173(1), sections 264, 264.1, 266 and 270, subsections 286.1(1) and 320.16(1), paragraph 348(1)(e) and sections 349 and 423 of the Criminal Code,

[ ] (iv) an offence under section 433 or 434 of the Criminal Code as that section read from time to time before July 1, 1990,

[ ] (iv.1) an offence under section 252 of the Criminal Code, as it read from time to time before the day on which section 14 of An Act to amend the Criminal Code (offences relating to conveyances) and to make consequential amendments to other Acts comes into force, or

[ ] (v) an attempt or a conspiracy to commit an offence referred to in any of subparagraphs (i) to (ii) that was prosecuted by indictment (or, if applicable, an attempt or a conspiracy to commit an offence referred to in subparagraph (iii) or (iv));

Whereas I have considered the offender’s criminal record, the nature of the offence, the circumstances surrounding its commission, whether the offender 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 offender’s privacy and security of the person;

And whereas I am 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 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.

This order 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 judge of the court)

1998, c. 37, s. 24; 2002, c. 1, s. 186; 2005, c. 25, s. 12; 2007, c. 22, s. 23; 2012, c. 1, s. 38; 2014, c. 25, s. 32; 2018, c. 16, s. 224, c. 21, s. 29.

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

Copy/Paste
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

Canada

Province of ____________

(territorial division)

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 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.

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)

2007, c. 22, s. 23.

Form 5.05 - Application for Authorization To Take Bodily Substances for Analysis

Copy/Paste
FORM 5.05
(Subsection 487.055(1))
Application for an Authorization To Take Bodily Substances for Forensic DNA Analysis
Canada
Province of ____________

(territorial division)

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)

1998, c. 37, s. 24; 2005, c. 25, s. 12; 2007, c. 22, s. 23.

Form 5.06 - Authorization To Take Bodily Substances for Analysis

Copy/Paste
FORM 5.06
(Subsection 487.055(1))
Authorization To Take Bodily Substances for Forensic DNA Analysis
Canada

Province of ____________

(territorial division)

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)

1998, c. 37, s. 24; 2005, c. 25, s. 12; 2007, c. 22, s. 23.

Form 5.061 - Summons to Person To Have Bodily Substances Taken for Analysis

Copy/Paste
FORM 5.061
(Subsections 487.055(4) and 487.091(3))
Summons to a Person To Have Bodily Substances Taken for Forensic DNA Analysis
Canada

Province of ____________

(territorial division)

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)

2007, c. 22, s. 23.

Form 5.062 - Warrant for Arrest

Copy/Paste
FORM 5.062
(Subsection 487.0551(1))
Warrant for Arrest
Canada
Province of ____________

(territorial division)

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 ____________

2007, c. 22, s. 23.

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

Copy/Paste
FORM 5.07
(Subsection 487.057(1))
Report to a Provincial Court Judge or the Court

Canada

Province of ____________

(territorial division)

[ ] 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)

1998, c. 37, s. 24; 2007, c. 22, s. 24.

Form 5.08 - Application for Authorization To Take Additional Samples of Bodily Substances Analysis

Copy/Paste
FORM 5.08
(Subsection 487.091(1))
Application for an Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis
Canada

Province of ____________

(territorial division)

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)

1998, c. 37, s. 24; 2005, c. 25, s. 13; 2007, c. 22, s. 25.

Form 5.09 - Authorization To Take Additional Samples of Bodily Substances for Analysis

Copy/Paste
FORM 5.09
(Subsection 487.091(1))
Authorization To Take Additional Samples of Bodily Substances for Forensic DNA Analysis
Canada
Province of ____________

(territorial division)

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)

1998, c. 37, s. 24; 2005, c. 25, s. 13; 2007, c. 22, s. 25.

Form 5.1 - Warrant To Search - Warrant To Search

Copy/Paste
FORM 5.1
(Section 487.1)
Warrant To Search

Canada,

Province of [specify province].

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.

Form 5.2 - Report to a Justice

Copy/Paste
FORM 5.2
(Section 489.1)
Report to a Justice

Canada,

Province of ____________,

(territorial division).

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

(describe each thing seized)

Disposition
(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. ____________ ____________
2. ____________ ____________
3. ____________ ____________
4. ____________ ____________

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).

_________________________ Signature of the peace officer or other person

R.S., 1985, c. 27 (1st Supp.), s. 184; 2018, c. 21, s. 31.


See Also

Form 5.3 - Report to a Judge of Property Seized

Copy/Paste
FORM 5.3
(Section 462.32)
Report to a Judge of Property Seized

Canada,

Province of ____________,

(territorial division).

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 ____________ .

Signature of peace officer or other person

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

Form 6 - Summons to Accused

Copy/Paste
FORM 6
(Section 2)
Summons to a Person Charged with an Offence

Canada,

Province of ________________

(territorial division).

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)

This provision came into force on December 18, 2019.

Form 7 - Warrant for Arrest

Copy/Paste
FORM 7
(Sections 475, 493, 597, 800 and 803)
Warrant for Arrest

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 7; R.S., 1985, c. 27 (1st Supp.), s.203; 1997, c. 39, s. 3; 1999, c. 5, s. 46.

Form 7.1 - Warrant To Enter Dwelling-house

Copy/Paste
FORM 7.1
(Section 529.1)
Warrant To Enter Dwelling-house

Canada,

Province of ____________,

(territorial division).

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.

1997, c. 39, s. 3; 2002, c. 13, s. 85.

Form 8 - Warrant for Committal

Copy/Paste
FORM 8
(Sections 493 and 515)
Warrant for Committal

Canada,

Province of ________________,

(territorial division).

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.

This provision came into force on December 18, 2019.

Form 9 - Appearance Notice

Copy/Paste
FORM 9
(Section 2)
Appearance Notice

Canada,

Province of ________________

(territorial division)

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)

This provision came into force on December 18, 2019.

Form 10 - Undertaking

Copy/Paste
FORM 10
(Section 2)
Undertaking

Canada,

Province of __________________________

(territorial division).

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):

☐ (a) You must report to (name or title) at (place) on (date or dates).
☐ (b) You must remain within the following territorial jurisdiction: __________________________
☐ (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)

This provision came into force on December 18, 2019.

Form 11 - Release Order

Copy/Paste
FORM 11
(Section 2)
Release Order

Canada,

Province of ________________

(territorial division).

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)


This provision came into force on December 18, 2019.

Form 11.1 - Undertaking Given to a Peace Officer or an Officer in Charge

Copy/Paste
FORM 11.1
(Sections 493, 499 and 503)
Undertaking Given to a Peace Officer or an Officer in Charge
Canada, Province of ____________,

(territorial division).

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)

1994, c. 44, s. 84; 1997, c. 18, s. 115; 1999, c. 25, s. 24; 2002, c. 13, s. 86(F); 2018, c. 29, s. 71.

Form 12 - Surety Declaration

Copy/Paste
FORM 12
(Section 515.1)
Surety Declaration

Canada,

Province of ________________,

(territorial division).

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)



This provision came into force on December 18, 2019.

Form 13 - Undertaking by Appellant (Defendant)

Copy/Paste
FORM 13
(Sections 816, 832 and 834)
Undertaking by Appellant (Defendant)

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 13; 1999, c. 25, s. 26.

Form 14 - Undertaking by Appellant (Prosecutor)

Copy/Paste
FORM 14
(Section 817)
Undertaking by Appellant (Prosecutor)

Canada,

Province of ____________,

(territorial division).

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)

Form 15 - Warrant To Convey Accused Before Justice of Another Territorial Division

Copy/Paste
FORM 15
(Section 543)
Warrant To Convey Accused Before Justice of Another Territorial Division

Canada,

Province of ____________,

(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 ____________

Form 16 - Subpoena to a Witness

Copy/Paste
FORM 16
(Section 699)
Subpoena to a Witness

Canada,

Province of ____________,

(territorial division).

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


Form 16.1 - Subpoena to a Witness in Respect of an Offence Referred to in s. 278.2(1)

Copy/Paste
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

Canada,

Province of ____________,

(territorial division).

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)

1997, c. 30, s. 3.

Form 17 - Warrant for Witness

Copy/Paste
FORM 17
(Sections 698 and 705)
Warrant for Witness

Canada,

Province of ____________,

(territorial division).

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

Form 18 - Warrant To Arrest an Absconding Witness

Copy/Paste
FORM 18
(Section 704)
Warrant To Arrest an Absconding Witness

Canada,

Province of ____________,

(territorial division).

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

Form 19 - Warrant Remanding a Prisoner

Copy/Paste
FORM 19
(Sections 516 and 537)
Warrant Remanding a Prisoner

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 19; R.S., 1985, c. 27 (1st Supp.), s. 184.

Form 20 - Warrant of Committal of Witness for Refusing to Be Sworn or to Give Evidence

Copy/Paste
FORM 20
(Section 545)
Warrant of Committal of Witness for Refusing to Be Sworn or to Give Evidence

Canada,

Province of ________________,

(territorial division).

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)

________________


This provision came into force on December 18, 2019.

Form 21 - Warrant of Committal on Conviction

Copy/Paste
FORM 21
(Sections 570 and 806)
Warrant of Committal on Conviction
Canada,
Province of ____________,
(territorial division).

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., 1985, c. C-46, Form 21; R.S., 1985, c. 27 (1st Supp.), s. 184; 1995, c. 22, s. 9; 2009, c. 29, s. 4.

Form 22 - Warrant of Committal on an Order for the Payment of Money

Copy/Paste
FORM 22
(Section 806)
Warrant of Committal on an Order for the Payment of Money

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 22; R.S., 1985, c. 27 (1st Supp.), s. 184.

Form 23 - Warrant of Committal for Failure To Furnish Recognizance To Keep the Peace

Copy/Paste
FORM 23
(Sections 810 and 810.1)
Warrant of Committal for Failure To Furnish Recognizance To Keep the Peace

Canada,

Province of ____________,

(territorial division).

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

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

Copy/Paste
FORM 24
(Section 550)
Warrant of Committal of Witness for Failure To Enter into Recognizance

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 24; R.S., 1985, c. 27 (1st Supp.), s. 184.

Form 25 - Warrant of Committal for Contempt

Copy/Paste
FORM 25
(Section 708)
Warrant of Committal for Contempt

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 25; R.S., 1985, c. 27 (1st Supp.), s. 184.

Form 26 - Warrant of Committal in Default of Payment of Costs of an Appeal

Copy/Paste
FORM 26
(Section 827)
Warrant of Committal in Default of Payment of Costs of an Appeal

Canada,

Province of ____________,

(territorial division).

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

Copy/Paste
FORM 27
(Section 773)
Warrant of Committal on Forfeiture of a Recognizance

Canada,

Province of _________,

(territorial division).

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

Form 28 - Endorsement of Warrant

Copy/Paste
FORM 28
(Section 528)
Endorsement of Warrant

Canada,

Province of ________________,

(territorial division).

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) ________________


This provision came into force on December 18, 2019.

Form 29 - Endorsement of Warrant

Copy/Paste
FORM 29
(Section 507)
Endorsement of Warrant

Canada,

Province of ____________,

(territorial division).

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., 1985, c. C-46, Form 29; 1994, c. 44, s. 84.

Form 30= - Order for Accused to Be Brought Before Justice Prior to Expiration of Remand

Copy/Paste
FORM 30
(Section 537)
Order for Accused to Be Brought Before Justice Prior to Expiration of Period of Remand

Canada,

Province of ________________,

(territorial division).

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) ________________


This provision came into force on December 18, 2019.

Form 31 - Deposition of a Witness

Copy/Paste
FORM 31
(Section 540)
Deposition of a Witness

Canada,

Province of ____________,

(territorial division).

These are the depositions of X.Y., of ____________, and M.N., of ____________, taken before me, this ____________ day of ____________ A.D., ____________ at ____________, in the presence and hearing of A.B., hereinafter called the accused, who stands charged (state offence as in the information).

X.Y., having been duly sworn, deposes as follows: (insert deposition as nearly as possible in words of witness).

M.N., having been duly sworn, deposes as follows:

I certify that the depositions of X.Y., and M.N., written on the several sheets of paper hereto annexed to which my signature is affixed, were taken in the presence and hearing of the accused (and signed by them respectively, in his presence where they are required to be signed by witness). In witness whereof I have hereto signed my name.

A Justice of the Peace in and for ____________

Form 32 - Recognizance

Copy/Paste
FORM 32
(Sections 2, 462.34, 490.9, 550, 683, 706, 707, 779, 810, 810.01, 810.1, 810.2, 817 and 832)
Recognizance

Canada,

Province of ________________

(territorial division)

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 of employer (if any): ________________

2 Financial Promise or Deposit

Pursuant to ________________ (provision) of the Criminal Code, I agree to (promise or deposit) the amount of $ ________________, or the other valuable security described here: ________________

I understand that if I fail to comply with any of the conditions listed below, this amount or security may be forfeited.

3 Conditions

(List the conditions that have been ordered by the court and indicate the duration for which each condition remains in effect.)

________________

4 Variation

I understand that I may apply to a judge or a justice of the peace to have any condition in this form cancelled or varied.

5 Conditions in effect

I understand that the conditions in this recognizance remain in effect until they are cancelled or changed or until I have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).

6 Signatures

PERSON WHO IS GIVING RECOGNIZANCE:

I understand the contents of this form and agree to comply with the conditions that are listed above.

Signed on ________________ (date), at ________________ (place).

________________ (Signature of the person) ________________ (Print name) SURETY (if applicable):

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

I agree to (promise or deposit) as security to the court the amount of $ ________________

I understand that if the person who is giving this recognizance fails to comply with any of the conditions in this recognizance, the money that I have promised or deposited may be forfeited.

Surety Declaration (if applicable)

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

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

Signed on ________________ (date), at ________________ (place).

________________ (Signature of the Surety) ________________ (Print name) JUDGE, PROVINCIAL COURT JUDGE, JUSTICE OR CLERK OF THE COURT:

Signed on ________________ (date), at ________________ (place).

________________ (Signature of the judge, provincial court judge, justice or clerk of the court) ________________ (Print name) List of Conditions

(a) has a surety (sections 462.34, 490.9, 550, 779, 810, 817 and 832 of the Criminal Code);

(b) agrees to keep the peace and be of good behaviour (sections 83.3, 810, 810.01, 810.1 and 810.2 of the Criminal Code);

(c) abstains from possessing a firearm, crossbow, prohibited weapon, restricted weapon, prohibited device, ammunition, prohibited ammunition or explosive substance and surrenders those in their possession and surrenders any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm (sections 83.3, 810, 810.01, 810.1 and 810.2 of the Criminal Code);

(d) participates in a treatment program (sections 810.01, 810.1 and 810.2 of the Criminal Code);

(e) wears an electronic monitoring device (if the Attorney General makes the request) (sections 810.01, 810.1 and 810.2 of the Criminal Code);

(f) remains within a specified geographic area unless written permission to leave that area is obtained from the judge (sections 810.01 and 810.2 of the Criminal Code);

(g) returns to and remains at their place of residence at specified times (sections 810.01, 810.1 and 810.2 of the Criminal Code);

(h) abstains from the consumption of drugs, except in accordance with a medical prescription (sections 810.01, 810.1 and 810.2 of the Criminal Code);

(i) abstains from the consumption of alcohol or of any other intoxicating substance, except in accordance with a medical prescription (sections 810.01, 810.1 and 810.2 of the Criminal Code);

(j) abstains from any contact — including communicating by any means — with a person under the age of 16 years, unless doing so under the supervision of a person whom the judge considers appropriate (section 810.1 of the Criminal Code);

(k) abstains from using the Internet or other digital network, unless doing so in accordance with conditions set by the judge (section 810.1 of the Criminal Code);

(l) abstains from attending a public park or public swimming area where persons under the age of 16 years are present or can reasonably be expected to be present, or a daycare centre, schoolground or playground (section 810.1 of the Criminal Code);

(m) appears personally or by counsel at the sittings of the appeal court at which the appeal is to be heard (sections 817 and 832 of the Criminal Code);

(n) appears in court as required (sections 550, 706 and 707 of the Criminal Code);

(o) in the case where a warrant was issued under section 462.32 of the Criminal Code or a restraint order was made under subsection 462.33(3) of that Act in relation to any property (set out a description of the property and its location), refrains from doing or causing anything to be done that would result, directly or indirectly, in the disappearance, dissipation or reduction in value of the property or otherwise affect the property so that all or a part thereof could not be subject to an order of forfeiture under section 462.37 or 462.38 of that Act or any other provision of that Act or any other Act of Parliament (section 462.34 of the Criminal Code);

(p) agrees to prosecute the writ of certiorari at their own expense, without wilful delay, and, if ordered, to pay to the person in whose favour the conviction, order or other proceeding is affirmed their full costs and charges to be taxed according to the practice of the court where the conviction, order or proceeding is affirmed (section 779 of the Criminal Code);

(q) any other reasonable conditions, including:

– reports at specified times to peace officer or other person designated;

– remains within designated territorial jurisdiction;

– notifies peace officer or other person designated of any change in their address, employment or occupation;

– abstains from communicating, directly or indirectly, with victim, witness or other specified person except in accordance with conditions specified by judge, provincial court judge or justice; and

– deposits all their passports as the judge, provincial court judge or justice directs.


This provision came into force on December 18, 2019.

Form 33 - Certificate of Default To Be Endorsed on Recognizance

Copy/Paste
FORM 33
(Section 770)
Certificate of Default To Be Endorsed on Recognizance

I hereby certify that A.B. (has not appeared as required by this recognizance or has not complied with a condition of this recognizance) and that by reason thereof the ends of justice have been (defeated or delayed, as the case may be).

The nature of the default is ____________ and the reason for the default is ____________ (state reason if known).

The names and addresses of the principal and sureties are as follows:

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

(Signature of justice, judge, provincial court judge, clerk of the court, peace officer or other person, as the case may be)

(Seal, if required)

R.S., 1985, c. C-46, Form 33; R.S., 1985, c. 27 (1st Supp.), s. 203; 1994, c. 44, s. 84.

Form 34 - Writ of Fieri Facias

Copy/Paste
FORM 34
(Section 771)
Writ of Fieri Facias
Elizabeth II by the Grace of God, etc.

To the sheriff of (territorial division), GREETING.

You are hereby commanded to levy of the goods and chattels, lands and tenements of each of the following persons the amount set opposite the name of each:

Name ____________ Address ____________ Occupation ____________ Amount

And you are further commanded to make a return of what you have done in execution of this writ.

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

Clerk of the ____________

(Seal)

Form 34.1 - Statement on Restitution

Copy/Paste
FORM 34.1
(Subsection 737.1(4))
Statement on Restitution

Canada,

Province of ____________,

(territorial division).

To the court that is sentencing (name the offender) who was convicted, or was discharged under section 730 of the Criminal Code, of an offence under that Act.

I, (name of declarant), declare that (check the appropriate box):

[ ] (i)

I am not seeking restitution for the losses and damages I suffered as the result of the commission of the offence. [ ] (ii)

I am seeking restitution in the amount of $____________ for the following losses and damages I suffered as the result of the commission of the offence.

I declare that I have suffered the following losses and damages as the result of the commission of the offence:

(Complete the following table if seeking restitution.)

Description

(describe each loss and damage)

Amount of loss and damage

(state the amount of each loss and damage)

1. ____________

____________

2. ____________

____________

3. ____________

____________

4. ____________

____________

I understand that the amount of my losses and damages must be readily ascertainable by the court. For that purpose, I am responsible for providing the court with all necessary documents, including bills, receipts and estimates, in support of my claim for restitution.

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

Signature of declarant

2011, c. 6, s. 5; 2015, c. 13, s. 35.

Form 34.2 - Victim Impact Statement

Copy/Paste
FORM 34.2
(Subsection 722(4))
Victim Impact Statement

This form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you as the result of the commission of an offence, as well as a description of the impact of the offence on you. You may attach additional pages if you need more space.

Your statement must not include

• any statement about the offence or the offender that is not relevant to the harm or loss you suffered;

• any unproven allegations;

• any comments about any offence for which the offender was not convicted;

• any complaint about any individual, other than the offender, who was involved in the investigation or prosecution of the offence; or

• except with the court’s approval, an opinion or recommendation about the sentence.

You may present a detailed account of the impact the offence has had on your life. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the offence has affected you emotionally. For example, think of

• your lifestyle and activities;

• your relationships with others such as your spouse, family and friends;

• your ability to work, attend school or study; and

• your feelings, emotions and reactions as they relate to the offence.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Physical impact

Describe how the offence has affected you physically. For example, think of

• ongoing physical pain, discomfort, illness, scarring, disfigurement or physical limitation;

• hospitalization or surgery you have had because of the offence;

• treatment, physiotherapy or medication you have been prescribed;

• the need for any further treatment or the expectation that you will receive further treatment; and

• any permanent or long-term disability.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Economic impact

Describe how the offence has affected you financially. For example, think of

• the value of any property that was lost or damaged and the cost of repairs or replacement;

• any financial loss due to missed time from work;

• the cost of any medical expenses, therapy or counselling;

• any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Fears for security

Describe any fears you have for your security or that of your family and friends. For example, think of

• concerns with respect to contact with the offender; and

• concerns with respect to contact between the offender and members of your family or close friends.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the offence has had on you.

 ____________

 ____________

 ____________

 ____________

 I would like to present my statement in court.

To the best of my knowledge, the information contained in this statement is true.

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

Signature of declarant

If you completed this statement on behalf of the victim, please indicate the reasons why you did so and the nature of your relationship with the victim.

 ____________ 

 ____________ 

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

Signature of declarant

2015, c. 13, s. 35.

Form 34.3 - Community Impact Statement

Copy/Paste
FORM 34.3
(Subsection 722.2(2))
Community Impact Statement

This form may be used to provide a description of the harm or loss suffered by a community as the result of the commission of an offence, as well as a description of the impact of the offence on the community. You may attach additional pages if you need more space.

Your statement must not include

• any statement about the offence or the offender that is not relevant to the harm or loss suffered by the community;

• any unproven allegations;

• any comments about any offence for which the offender was not convicted;

• any complaint about any individual, other than the offender, who was involved in the investigation or prosecution of the offence; or

• except with the court’s approval, an opinion or recommendation about the sentence.

Name of community on whose behalf the statement is made: ____________

Explain how the statement reflects this community’s views:

 ____________ 

 ____________ 

 ____________ 

 ____________ 

You may present a detailed account of the impact the offence has had on the community. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the offence has affected community members emotionally. For example, think of

• community members’ lifestyles and activities;

• community members’ relationships with others in the community and outside it;

• community members’ ability to work, attend school or study;

• community members’ feelings, emotions and reactions as they relate to the offence; and

• the community’s sense of belonging to the region.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Physical impact

Describe how the offence has affected community members physically. For example, think of

• the ability of community members to access services; and

• changes in transportation and routes taken to and from school, work, shopping, etc.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Economic impact

Describe how the offence has affected the community financially. For example, think of

• any reduction in the number of visitors or tourists to the region;

• the value of any property that was lost or damaged and the cost of repairs or replacement; and

• any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Fears for security

Describe any fears that community members have for their security or that of their family and friends. For example, think of concerns with respect to contact with the offender.

 ____________

 ____________

 ____________

 ____________

Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the offence has had on the community.

 ____________

 ____________

 ____________

 ____________

 I would like to present this statement in court.

To the best of my knowledge, the information contained in this statement is true.

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

Signature of declarant

2015, c. 13, s. 35.

Form 35 - Conviction

Copy/Paste
FORM 35
(Sections 570 and 806)
Conviction

Canada,

Province of ____________,

(territorial division).

Be it remembered that on the ____________ day of ____________ at ____________, A.B., (date of birth) hereinafter called the accused, was tried under Part (XIX or XXVII) of the Criminal Code on the charge that (state fully the offence of which accused was convicted), was convicted of the said offence and the following punishment was imposed on him, namely,*

  • Use whichever of the following forms of sentence is applicable:

(a) that the said accused be imprisoned in the (prison) at ____________ for the term of ____________;

(b) that the said accused forfeit and pay the sum of ____________ dollars to be applied according to law and also pay to ____________ the sum of ____________ dollars in respect of costs and in default of payment of the said sums forthwith (or within a time fixed, if any), to be imprisoned in the (prison) at ____________ for the term of ____________ unless the said sums and the costs and charges of the committal and of conveying the accused to the said prison are sooner paid;

(c) that the said accused be imprisoned in the (prison) at ____________ for the term of ____________ and in addition forfeit and pay the sum of ____________ dollars to be applied according to law and also pay to ____________ the sum of ____________ dollars in respect of costs and in default of payment of the said sums forthwith (or within a time fixed, if any), to be imprisoned in the (prison) at ____________ for the term of ____________ (if sentence to be consecutive, state accordingly) unless the said sums and the costs and charges of the committal and of conveying the accused to the said prison are sooner paid.

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

Clerk of the Court, Justice or Provincial Court Judge

(Seal, if required)

R.S., 1985, c. C-46, Form 35; R.S., 1985, c. 27 (1st Supp.), ss. 184, 203.

Form 36 - Order Against an Offender

Copy/Paste
FORM 36
(Sections 570 and 806)
Order Against an Offender

Canada,

Province of ____________,

(territorial division).

Be it remembered that on the ____________ day of ____________ A.D. ____________, at ____________, A.B., (date of birth) of ____________, was tried on an information (indictment) alleging that (set out matter of complaint or alleged offence), and it was ordered and adjudged that (set out the order made).

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

Justice or Clerk of the Court

R.S., 1985, c. C-46, Form 36; R.S., 1985, c. 27 (1st Supp.), s. 184.

Form 37 - Order Acquitting Accused

Copy/Paste
FORM 37
(Section 570)
Order Acquitting Accused

Canada,

Province of ____________,

(territorial division).

Be it remembered that on the ____________ day of ____________ A.D. ____________, at ____________ A.B., of ____________, (occupation), (date of birth) was tried on the charge that (state fully the offence of which accused was acquitted) and was found not guilty of the said offence.

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

Provincial Court Judge or Clerk of the Court

(Seal, if required)

R.S., 1985, c. C-46, Form 37; R.S., 1985, c. 27 (1st Supp.), ss. 184, 203.

==Form 38 - Conviction for Contempt ==

Copy/Paste
FORM 38
(Section 708)
Conviction for Contempt

Canada,

Province of ____________,

(territorial division).

Be it remembered that on the ____________ day of ____________ A.D. ____________, at ____________ in the (territorial division), E.F. of ____________, hereinafter called the defaulter, is convicted by me for contempt in that he did not attend before (set out court or justice) to give evidence on the trial of a charge that (state fully offence with which accused was charged), although (duly subpoenaed or bound by recognizance to attend to give evidence, as the case may be) and has not shown before me any sufficient excuse for his default;

Wherefore I adjudge the defaulter for his said default, (set out punishment as authorized and determined in accordance with section 708 of the Criminal Code).

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

A Justice or Clerk of the Court

(Seal, if required)

Form 39- Order for Discharge of a Person in Custody

Copy/Paste
FORM 39
(Sections 519 and 550)
Order for Discharge of a Person in Custody

Canada,

Province of ____________,

(territorial division).

To the keeper of the (prison) at ____________:

I hereby direct you to release E.F., detained by you under a (warrant of committal or order) dated the ____________ day of ____________ A.D. ____________, if the said E.F. is detained by you for no other cause.

A Judge, Justice or Clerk of the Court

(Seal, if required)

Form 40 - Challenge To Array

Copy/Paste
FORM 40
(Section 629)
Challenge To Array

Canada,

Province of ____________,

(territorial division).

The Queen

v.

C.D.

The (prosecutor or accused) challenges the array of the panel on the ground that X.Y., (sheriff or deputy sheriff), who returned the panel, was guilty of (partiality or fraud or wilful misconduct) on returning it.

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

Counsel for (prosecutor or accused)

Form 41 - Challenge for Cause

Copy/Paste
FORM 41
(Section 639)
Challenge for Cause

Canada,

Province of ____________,

(territorial division).

The Queen

v.

C.D.

The (prosecutor or accused) challenges G.H. on the ground that (set out ground of challenge in accordance with subsection 638(1) of the Criminal Code).

Counsel for (prosecutor or accused)

Form 42 - Certificate of Non-payment of Costs of Appeal

Copy/Paste
FORM 42
(Section 827)
Certificate of Non-payment of Costs of Appeal

In the Court of ____________

(Style of Cause)

I hereby certify that A.B. (the appellant or respondent, as the case may be) in this appeal, having been ordered to pay costs in the sum of ____________ dollars, has failed to pay the said costs within the time limited for the payment thereof.

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

Clerk of the Court of ____________

(Seal)

Form 43 - Jailer’s Receipt to Peace Officer for Prisoner

Copy/Paste
FORM 43
(Section 744)
Jailer’s Receipt to Peace Officer for Prisoner

I hereby certify that I have received from X.Y., a peace officer for (territorial division), one A.B., together with a (warrant or order) issued by (set out court or justice, as the case may be).*

  • Add a statement of the condition of the prisoner

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

Keeper of (prison)

R.S., 1985, c. C-46, Form 43; 1995, c. 22, s. 18.

Form 44

(Proof of conviction by fingerprint examiner)

Copy/Paste
FORM 44
(Section 667)

I, (name), a fingerprint examiner designated as such for the purposes of section 667 of the Criminal Code by the Minister of Public Safety and Emergency Preparedness, do hereby certify that (name) also known as (aliases if any), FPS Number ____________, whose fingerprints are shown reproduced below (reproduction of fingerprints) or attached hereto, has been convicted, discharged under section 730 of the Criminal Code or convicted and sentenced in Canada as follows:

(record)

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

Fingerprint Examiner

R.S., 1985, c. C-46, Form 44; R.S., 1985, c. 27 (1st Supp.), s. 184, c. 1 (4th Supp.), s. 18; 1995, c. 22, s. 18; 2005, c. 10, s. 34.

Form 45

(Proof of conviction by fingerprint examiner)

Copy/Paste
FORM 45
(Section 667)

I, (name), a fingerprint examiner designated as such for the purposes of section 667 of the Criminal Code by the Minister of Public Safety and Emergency Preparedness, do hereby certify that I have compared the fingerprints reproduced in or attached to exhibit A with the fingerprints reproduced in or attached to the certificate in Form 44 marked exhibit B and that they are those of the same person.

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

Fingerprint Examiner

R.S., 1985, c. C-46, Form 45; R.S., 1985, c. 27 (1st Supp.), s. 184; 2005, c. 10, s. 34.

Form 46 - Probation Order

Copy/Paste
FORM 46
(Section 732.1)
Probation Order

Canada,

Province of ____________,

(territorial division).

Whereas on the ____________ day of ____________ at ____________, A.B., hereinafter called the offender, (pleaded guilty to or was tried under (here insert Part XIX, XX or XXVII, as the case may be) of the Criminal Code and was (here insert convicted or found guilty, as the case may be) on the charge that (here state the offence to which the offender pleaded guilty or for which the offender was convicted or found guilty, as the case may be);

And whereas on the ____________ day of ____________ the court adjudged*

  • Use whichever of the following forms of disposition is applicable:
(a) that the offender be discharged on the following conditions:
(b) that the passing of sentence on the offender be suspended and that the said offender be released on the following conditions:
(c) that the offender forfeit and pay the sum of ____________ dollars to be applied according to law and in default of payment of the said sum without delay (or within a time fixed, if any), be imprisoned in the (prison) at ____________ for the term of ____________ unless the said sum and charges of the committal and of conveying the said offender to the said prison are sooner paid, and in addition thereto, that the said offender comply with the following conditions:
(d) that the offender be imprisoned in the (prison) at ____________ for the term of ____________ and, in addition thereto, that the said offender comply with the following conditions:
(e) that following the expiration of the offender’s conditional sentence order related to this or another offence, that the said offender comply with the following conditions:
(f) that following the expiration of the offender’s sentence of imprisonment related to another offence, that the said offender comply with the following conditions:
(g) when the offender is ordered to serve the sentence of imprisonment intermittently, that the said offender comply with the following conditions when not in confinement:

Now therefore the said offender shall, for the period of ____________ from the date of this order (or, where paragraph (d), (e) or (f) is applicable, the date of expiration of the offender’s sentence of imprisonment or conditional sentence order) comply with the following conditions, namely, that the said offender shall keep the peace and be of good behaviour, appear before the court when required to do so by the court and notify the court or probation officer in advance of any change of name or address and promptly notify the court or probation officer of any change of employment or occupation, and, in addition,

(here state any additional conditions prescribed pursuant to subsection 732.1(3) of the Criminal Code).

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

Clerk of the Court, Justice or Provincial Court Judge

R.S., 1985, c. C-46, Form 46; R.S., 1985, c. 27 (1st Supp.), s. 203; 1995, c. 22, s. 10; 2004, c. 12, s. 17.

Form 47 - Order To Disclose Income Tax Information

Copy/Paste
FORM 47
(Section 462.48)
Order To Disclose Income Tax Information

Canada,

Province of ____________,

(territorial division).

To A.B., of ____________, (office or occupation):

Whereas, it appears on the oath of C.D., of ____________, that there are reasonable grounds for believing that E.F., of ____________, has committed or benefited from the commission of the offence of ____________ and that the information or documents (describe information or documents) are likely to be of substantial value to an investigation of that offence or a related matter; and

Whereas there are reasonable grounds for believing that it is in the public interest to allow access to the information or documents, having regard to the benefit likely to accrue to the investigation if the access is obtained;

This is, therefore, to authorize and require you between the hours of (as the judge may direct), during the period commencing on ____________ and ending on ____________, to produce all the above-mentioned information and documents to one of the following police officers, namely, (here name police officers) and allow the police officer to remove the information or documents, or to allow the police officer access to the above-mentioned information and documents and to examine them, as the judge directs, subject to the following conditions (state conditions): ____________

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

Signature of judge

R.S., 1985, c. 42 (4th Supp.), s. 8.

Form 48 - Assessment Order of the Court

Copy/Paste
FORM 48
(Section 672.13)
Assessment Order of the Court

Canada,

Province of

(territorial division)

Whereas I have reasonable grounds to believe that evidence of the mental condition of (name of accused), who has been charged with ____________, may be necessary to determine *

[ ] whether the accused is unfit to stand trial
[ ] whether the accused suffered from a mental disorder so as to exempt the accused from criminal responsibility by virtue of subsection 16(1) of the Criminal Code at the time of the act or omission charged against the accused
[ ] whether the balance of the mind of the accused was disturbed at the time of commission of the alleged offence, if the accused is a female person charged with an offence arising out of the death of her newly-born child
[ ] if a verdict of unfit to stand trial or a verdict of not criminally responsible on account of mental disorder has been rendered in respect of the accused, the appropriate disposition to be made in respect of the accused under section 672.54, 672.58 or 672.64 of the Criminal Code or whether the court should, under subsection 672.84(3) of that Act, revoke a finding that the accused is a high-risk accused
[ ] if a verdict of unfit to stand trial has been rendered in respect of the accused, whether the court should order a stay of proceedings under section 672.851 of the Criminal Code

I hereby order an assessment of the mental condition of (name of accused) to be conducted by/at (name of person or service by whom or place where assessment is to be made) for a period of ____________ days.

This order is to be in force for a total of ____________ days, including travelling time, during which time the accused is to remain *

[ ] in custody at (place where accused is to be detained)
[ ] out of custody, on the following conditions:

(set out conditions, if applicable)

  • Check applicable option.

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

(Signature of justice or judge or clerk of the court, as the case may be)

1991, c. 43, s. 8; 1995, c. 22, s. 10; 2005, c. 22, s. 40; 2014, c. 6, s. 19.

Form 48.1 - Assessment Order of the Review Board

Copy/Paste
FORM 48.1
(Section 672.13)
Assessment Order of the Review Board
Canada,

Province of

(territorial division)

Whereas I have reasonable grounds to believe that evidence of the mental condition of (name of accused), who has been charged with ____________, may be necessary to *

[ ] if a verdict of unfit to stand trial or a verdict of not criminally responsible on account of mental disorder has been rendered in respect of the accused, make a disposition under section 672.54 of the Criminal Code or determine whether the Review Board should, under subsection 672.84(1) of that Act, refer to the superior court of criminal jurisdiction for review a finding that the accused is a high-risk accused

[ ] if a verdict of unfit to stand trial has been rendered in respect of the accused, determine whether the Review Board should make a recommendation to the court that has jurisdiction in respect of the offence charged against the accused to hold an inquiry to determine whether a stay of proceedings should be ordered in accordance with section 672.851 of the Criminal Code

I hereby order an assessment of the mental condition of (name of accused) to be conducted by/at (name of person or service by whom or place where assessment is to be made) for a period of ____________ days.

This order is to be in force for a total of ____________ days, including travelling time, during which time the accused is to remain *

[ ] in custody at (place where accused is to be detained)

[ ] out of custody, on the following conditions:

(set out conditions, if applicable)

  • Check applicable option.

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

(Signature of Chairperson of the Review Board)

2005, c. 22, s. 40; 2014, c. 6, s. 20.

Form 48.2 - Victim Impact Statement — Not Criminally Responsible

Copy/Paste
FORM 48.2
(Subsection 672.5(14))
Victim Impact Statement — Not Criminally Responsible

This form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you arising from the conduct for which the accused person was found not criminally responsible on account of mental disorder, as well as a description of the impact that the conduct has had on you. You may attach additional pages if you need more space.

Your statement must not include

• any statement about the conduct of the accused that is not relevant to the harm or loss suffered by you;

• any unproven allegations;

• any comments about any conduct for which the accused was not found not criminally responsible;

• any complaint about any individual, other than the accused, who was involved in the investigation or prosecution of the offence; or

• except with the court’s or Review Board’s approval, an opinion or recommendation about the disposition.

The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the accused’s conduct has affected you emotionally. For example, think of

• your lifestyle and activities;

• your relationships with others such as your spouse, family and friends;

• your ability to work, attend school or study; and

• your feelings, emotions and reactions as these relate to the conduct.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Physical impact

Describe how the accused’s conduct has affected you physically. For example, think of

• ongoing physical pain, discomfort, illness, scarring, disfigurement or physical limitation;

• hospitalization or surgery you have had because of the conduct of the accused;

• treatment, physiotherapy or medication you have been prescribed;

• the need for any further treatment or the expectation that you will receive further treatment; and

• any permanent or long-term disability.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Economic impact

Describe how the accused’s conduct has affected you financially. For example, think of

• the value of any property that was lost or damaged and the cost of repairs or replacement;

• any financial loss due to missed time from work;

• the cost of any medical expenses, therapy or counselling; and

• any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Fears for security

Describe any fears you have for your security or that of your family and friends. For example, think of

• concerns with respect to contact with the accused; and

• concerns with respect to contact between the accused and members of your family or close friends.

 ____________ 

 ____________ 

 ____________ 

 ____________ 

Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the accused’s conduct has had on you.

 ____________

 ____________

 ____________

 ____________

 I would like to read or present my statement (in court or before the Review Board).

To the best of my knowledge, the information contained in this statement is true.

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

Signature of declarant

2015, c. 13, s. 36.

Form 49

Copy/Paste
FORM 49
(Section 672.57)
Warrant of Committal
Disposition of Detention

Canada,

Province of

(territorial division)

To the peace officers in the said (territorial division) and to the keeper (administrator, warden) of the (prison, hospital or other appropriate place where the accused is detained).

This warrant is issued for the committal 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 was charged);

And whereas the accused was found*

☐ unfit to stand trial

☐ not criminally responsible on account of mental disorder

This is, therefore, to command you, in Her Majesty’s name, to take the accused in custody and convey the accused safely to the (prison, hospital or other appropriate place) at ____________, and there deliver the accused to the keeper (administrator, warden) with the following precept:

I do therefore command you the said keeper (administrator, warden) to receive the accused in your custody in the said (prison, hospital or other appropriate place) and to keep the accused safely there until the accused is delivered by due course of law.

The following are the conditions to which the accused shall be subject while in your (prison, hospital or other appropriate place):

The following are the powers regarding the restrictions (and the limits and conditions on those restrictions) on the liberty of the accused that are hereby delegated to you the said keeper (administrator, warden) of the said (prison, hospital or other appropriate place):

  • Check applicable option.

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

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

1991, c. 43, s. 8.

Form 50

Copy/Paste
FORM 50
(Subsection 672.7(2))
Warrant of Committal
Placement Decision

Canada,

Province of

(territorial division)

To the peace officers in the said (territorial division) and to the keeper (administrator, warden) of the (prison, hospital or other appropriate place where the accused is detained).

This warrant is issued for the committal 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 was charged);

And whereas the accused was found*

☐ unfit to stand trial

☐ not criminally responsible on account of mental disorder

And whereas the Review Board has held a hearing and decided that the accused shall be detained in custody;

And whereas the accused is required to be detained in custody pursuant to a warrant of committal issued by (set out the name of the Judge, Clerk of the Court, Provincial Court Judge or Justice as well as the name of the court and territorial division), dated the ____________ day of ____________, in respect of the offence that (set out briefly the offence in respect of which the accused was charged or convicted);

This is, therefore, to command you, in Her Majesty’s name, to*

☐ execute the warrant of committal issued by the court, according to its terms

☐ execute the warrant of committal issued herewith by the Review Board

  • Check applicable option.

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

(Signature of chairperson of the Review Board)

1991, c. 43, s. 8.

Form 51

Copy/Paste
FORM 51
(Paragraphs 732.1(3)(c.2), 742.3(2)(a.2), 810(3.02)(c), 810.01(4.1)(g), 810.011(6)(f), 810.1(3.02)(i) and 810.2(4.1)(g))
Notice of Obligation To Provide Samples of Bodily Substance

To A.B., of ____________, (occupation), (address in Canada), (date of birth), (gender):

Because, on (date), you were ordered, under (applicable provision) of the Criminal Code, to provide samples of a bodily substance prescribed by regulation at regular intervals for the purpose of analysis;

You are provided with this notice to inform you of your obligations with respect to providing samples.

1 On (specify a day not earlier than 24 hours after the day on which the notice is served), you must report, at any time from (time) to (time), at (address of place at which sample to be taken, as designated by the Attorney General of the province or Minister of Justice of the territory), to provide a sample of your (specify type of bodily substance prescribed by regulation).

2 Every (specify a number not less than seven) days after you first report to provide a sample, you must report, at any time from (time) to (time), at (address of place at which sample to be taken, as designated by the Attorney General of the province or Minister of Justice of the territory), to provide a sample of your (specify type of bodily substance prescribed by regulation).

3 You have the right to apply to a court to terminate the obligation to provide samples, and the right to appeal any decision of that court.

4 If you are found to have not complied with your obligation to provide samples as set out in this notice, you may be subject to a fine or imprisonment, or to both (or, in the case of a conditional sentence, you may be subject to proceedings under section 742.6 of the Criminal Code, the consequences of which may include imprisonment).

5 The results of the analysis of the bodily substances may be used or disclosed in accordance with the Criminal Code, including in proceedings against you, the result of which may be that you are subject to a fine or imprisonment, or to both (or, in the case of a conditional sentence, including in proceedings under section 742.6 of the Criminal Code, the consequences of which may include imprisonment).

Served on (date), at (place the notice is served).

(Signature of probation officer, supervisor or person designated by the Attorney General or Minister of Justice, as the case may be)

1991, c. 43, s. 8; 1995, c. 22, s. 10 (Sch. I, item 37); 2005, c. 22, s. 41; 2011, c. 7, s. 13; 2015, c. 20, s. 34.

Form 52 - Order To Comply with Sex Offender Information Registration Act

Copy/Paste
FORM 52
(Section 490.012)
Order To Comply with Sex Offender Information Registration Act

Canada,

Province of ____________

(territorial division)

To A.B., of ____________, (occupation), (address or address of court if no fixed address), (date of birth), (gender):

You have been convicted of or found not criminally responsible on account of mental disorder for (description of offence(s)) under (applicable designated offence provision(s) of theCriminal Code), a designated offence (or designated offences) within the meaning of subsection 490.011(1) of the Criminal Code.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(1) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of ____________ years after this order is made (or if paragraph 490.013(2)(c) or any of subsections 490.013(2.1) to (5) of the Criminal Code applies, for life).

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act or, if applicable, the Canadian Forces Provost Marshal, to correct the information.

6 You have the right to apply to a court to terminate this order, and the right to appeal the decision of that court.

7 If you are found to have contravened this order, you may be subject to a fine or imprisonment, or to both.

8 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Dated this ____________ day of ____________, at ____________ .

(Signature of judge or clerk and name of court)

(Signature of person subject to order)

2004, c. 10, s. 21; 2007, c. 5, s. 30; 2010, c. 17, s. 26; 2013, c. 24, s. 117(F).

Form 53

Copy/Paste
FORM 53
(Sections 490.019 and 490.032)
Notice of Obligation To Comply with Sex Offender Information Registration Act

Canada,

Province of ____________,

(territorial division).

To A.B., of ____________, (occupation), a person referred to in subsection 490.02(1) of the Criminal Code:

Because, on ____________ (insert date(s)), you were convicted of, or found not criminally responsible on account of mental disorder for, ____________ (insert description of offence(s)), one or more offences referred to in paragraph (a), (c), (c.1), (d), (d.1) or (e) of the definition designated offence in subsection 490.011(1) of the Criminal Code or in paragraph (a) or (c) of the definition designated offence in section 227 of the National Defence Act, under ____________ (insert the applicable offence provision(s)), this is provided to give you notice that you are required to comply with the Sex Offender Information Registration Act.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(2) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of ____________ years after you were sentenced, or found not criminally responsible on account of mental disorder, for the offence (or if paragraph 490.022(3)(c) or (d) of the Criminal Code applies, for life) or for any shorter period set out in subsection 490.022(2) of the Criminal Code.

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act or, if applicable, the Canadian Forces Provost Marshal, to correct the information.

6 You have the right to apply to a court to exempt you from the obligation to comply with the Sex Offender Information Registration Act, and the right to appeal any decision of that court.

7 You have the right to apply to a court to terminate the obligation, and the right to appeal any decision of that court.

8 If you are found to have contravened the obligation, you may be subject to a fine or imprisonment, or to both.

9 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Dated this ____________ day of ____________, at ____________ .

2004, c. 10, s. 21; 2007, c. 5, s. 31; 2013, c. 24, s. 117(F); 2014, c. 25, s. 33.

Form 54 - Obligation To Comply with SOIRA

Copy/Paste
FORM 54
(Sections 490.02901 to 490.02903, 490.02905 and 490.032)
Obligation To Comply with Sex Offender Information Registration Act

To A.B., of ____________, (occupation), (address in Canada), (date of birth), (gender):

Because, on (date), you were convicted of or found not criminally responsible on account of mental disorder for an offence (or offences) in (location of offence(s)) that the Attorney General of the province, or the minister of justice of the territory, has identified as being equivalent to (description of offence(s)) under (applicable provision(s) of theCriminal Code), a designated offence (or designated offences) as defined in subsection 490.011(1) of the Criminal Code;

You are provided with this to inform you that you are required to comply with the Sex Offender Information Registration Act.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(2) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of ____________ years after the day on which you were sentenced or found not criminally responsible on account of mental disorder for the offence (or if paragraph 490.02904(3)(c) or (d) of the Criminal Code applies, for life because you were convicted of or found not criminally responsible on account of mental disorder for (description of offence(s)) under (applicable designated offence provision(s) of theCriminal Code), a designated offence (or designated offences) within the meaning of subsection 490.011(1) of the Criminal Code) or for any shorter period determined under subsection 490.02904(2) of the Criminal Code.

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act to correct the information.

6 You have the right to apply to a court to exempt you from the obligation to comply with the Sex Offender Information Registration Act, and the right to appeal the decision of that court.

7 You have the right to apply to a court to terminate the obligation to comply with the Sex Offender Information Registration Act and the right to appeal the decision of that court.

8 If you are found to have not complied with the Sex Offender Information Registration Act, you may be subject to a fine or imprisonment, or to both.

9 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Served on (date).

____________

For administrative use only:

Sentence imposed or verdict of not criminally responsible on account of mental disorder rendered on (date).

2010, c. 17, s. 27.

See Also

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