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)

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)

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)

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)