Form 5.041

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 order you, in Her Majesty’s name, to appear on  (date)  , at  (hour), at ( place), for the purpose of the taking of bodily substances by means of the investigative procedures set out in subsection 487.‍06(1) of the Criminal Code.

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

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

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

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

487.0552 (1) Every person who, without reasonable excuse, fails to comply with an order made under subsection 487.051(4) or 487.055(3.11) of this Act or under subsection 196.14(4) or 196.24(4) of the National Defence Act, or with a summons referred to in subsection 487.055(4) or 487.091(3) of this Act, is guilty of

(a) an indictable offence and liable to imprisonment for a term of not more than two years; or

(b) an offence punishable on summary conviction.

Dated (date) , at  (place).

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

Form 5.05

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 Codeand 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)

Form 5.06

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)

Form 5.061

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 (date) , at  (place).

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

Form 5.062

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 

Form 5.07

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)

Form 5.08

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)

Form 5.09

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)

Form 5.1

FORM 5.1 (Sections 320.29 and 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.

Form 5.2

FORM 5.2 (Section 489.1)

Report to a JusticeCanada,

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 Code or 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.)

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

Form 5.3

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).

Dated this  day of  A.D.  , at  .

Signature of peace officer or other person

Form 6

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)

Form 7

FORM 7 

(Sections 475, 493, 597, 800 and 803)

Warrant for Arrest

Canada,

Province of .‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍.‍,

(territorial division).

To the peace officers in the (territorial division):

This warrant is issued for the arrest 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) 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 the accused [512(2)];

□ (c) (an appearance notice or undertaking) was confirmed and the accused failed to attend court in accordance with it [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 (summons or appearance notice or undertaking or release order) on which the accused was released [512.‍3];

□ (g) there are reasonable grounds to believe that the accused has committed an indictable offence since their release from custody on (summons or appearance notice or undertaking or release order) [512.‍3];

□ (h) the accused was required by (appearance notice or undertaking or summons) to attend at a time and place stated in it for the purposes of the Identification of Criminals Act and did not appear at that time and place [512.‍1, 512.‍2];

□ (i) an indictment has been found against the accused and the accused has not appeared or remained in attendance before the court for their trial [597];

□ (j) (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 immediately arrest the accused and to bring them before (state court, judge or justice), to be dealt with according to law.

□ (Check if applicable) Because there are reasonable grounds to believe that the accused is or will be present in (specify dwelling-house), this warrant is also issued to authorize you to enter the dwelling-house for the purpose of arresting 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 is present in the dwelling-house.

Signed on (date), at (place).

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

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

Form 7.1

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

Form 8

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.

Form 9

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)

Form 10

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)

Form 11

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)

Form 11.1

FORM 11.1

[Repealed, 2019, c. 25, s. 337]

Form 12

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)