Province of ,
In the (set out name of the court)
Her Majesty the Queen
(name of accused)
(Name of accused) stands charged
Dated this day of A.D. , at .
(Signature of signing officer, Agent of Attorney General, etc., as the case may be)
Note: The date of birth of the accused may be mentioned on the information or indictment.
- R.S., 1985, c. C-46, Form 4
- R.S., 1985, c. 27 (1st Supp.), s. 184
- 1999, c. 3, s. 58
- Date modified: