Criminal Code

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.