Criminal Code Forms (Form 31 to 54)

See also: Criminal Code Forms

Form 31 - Deposition of a Witness

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 31

Deposition of a Witness

(Section 540)

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

Canada,
Province of ____________,
(territorial division).

FORM 32

Recognizance

(Sections 2, 462.34, 490.9, 550, 683, 706, 707, 779, 810, 810.01, 810.1, 810.2, 817 and 832)

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.

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; 2019, c. 25, s. 348.

Form 33 - Certificate of Default to Be Endorsed

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 33

Certificate of Default to Be Endorsed

(Section 770)

It is certified that A.B. (has not appeared as required by this undertaking, release order or recognizance or has not complied with a condition of this undertaking, release order or recognizance) and that for this reason the ends of justice have been (defeated or delayed, as the case may be).

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

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

Dated (date)blank line, at blank line(place). blank line (Signature of judge, provincial court judge, justice, clerk of the court, peace officer or other person)

(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; 2019, c. 25, s. 349.

Form 34 - Writ of Fieri Facias

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 34

Writ of Fieri Facias

(Section 771)

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

Canada,
Province of ____________,
(territorial division).

FORM 34.1

Statement on Restitution

(Subsection 737.1(4))

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

Canada,
Province of ____________,
(territorial division).

FORM 34.2

Victim Impact Statement

(Subsection 722(4))

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

Canada,
Province of ____________,
(territorial division).

FORM 34.3

Community Impact Statement

(Subsection 722.2(2))

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

Canada,
Province of ____________,
(territorial division).

FORM 35

Conviction

(Sections 570 and 806)

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

Canada,
Province of ____________,
(territorial division).

FORM 36

Order Against an Offender

(Sections 570 and 806)

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

Canada,
Province of ____________,
(territorial division).

FORM 37

Order Acquitting Accused

(Section 570)

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

See also: Contempt of Court (Offence)

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 38

Conviction for Contempt

(Section 708)

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

Canada,
Province of ____________,
(territorial division).

FORM 39

Order for Discharge of a Person in Custody

(Sections 519 and 550)

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

Canada,
Province of ____________,
(territorial division).

FORM 40

Challenge To Array

(Section 629)

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

Canada,
Province of ____________,
(territorial division).

FORM 41

Challenge for Cause

(Section 639)

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

Canada,
Province of ____________,
(territorial division).

FORM 42

Certificate of Non-payment of Costs of Appeal

(Section 827)

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

Canada,
Province of ____________,
(territorial division).

FORM 43

Jailer’s Receipt to Peace Officer for Prisoner

(Section 744)

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

(Proof of conviction by fingerprint examiner)

Copy/Paste

Canada,
Province of ____________,
(territorial division).

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

(Proof of conviction by fingerprint examiner)

Copy/Paste

Canada,
Province of ____________,
(territorial division).

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

Canada,
Province of ____________,
(territorial division).

FORM 46

Probation Order

(Section 732.1)

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

Canada,
Province of ____________,
(territorial division).

FORM 47

Order To Disclose Income Tax Information

(Section 462.48)

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

Canada,
Province of ____________,
(territorial division).

FORM 48

Assessment Order of the Court

(Section 672.13)

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

Canada,
Province of ____________,
(territorial division).

FORM 48.1

Assessment Order of the Review Board

(Section 672.13)

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

Canada,
Province of ____________,
(territorial division).

FORM 48.2

Victim Impact Statement — Not Criminally Responsible

(Subsection 672.5(14))

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 - Warrant of Committal

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 49

Warrant of Committal

Disposition of Detention

(Section 672.57)

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 - Warrant of Committal

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 50

Warrant of Committal
Placement Decision

(Subsection 672.7(2))

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 - Notice of Obligation To Provide Samples of Bodily Substance

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 51

Notice of Obligation To Provide Samples of Bodily Substance

(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))

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 SOIRA

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 52

Order To Comply with Sex Offender Information Registration Act

(Section 490.012)

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 - Notice of Obligation To Comply with SOIRA

Copy/Paste

Canada,
Province of ____________,
(territorial division).

FORM 53

Notice of Obligation To Comply with Sex Offender Information Registration Act

(Sections 490.019 and 490.032)

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

Canada,
Province of ____________,
(territorial division).

FORM 54

Obligation To Comply with Sex Offender Information Registration Act

(Sections 490.02901 to 490.02903, 490.02905 and 490.032)

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.