Canadian Security Intelligence Service Act (R.S.C., 1985, c. C-23)

(Court File No.)

FEDERAL COURT

IN THE MATTER OF an application by (Name) for a preservation order under section (12 or 16) and subsection 20.3(2) of the Canadian Security Intelligence Service Act, R.S.C. 1985, c. C-23

AND IN THE MATTER OF (Subject)

This is the information of (name of Director or designated employee), of (“the applicant”).

The applicant says that they have reasonable grounds to suspect that (specify the information, record, document or thing) is in the possession or control of (name of the person or entity) and will assist the Canadian Security Intelligence Service to investigate, within or outside Canada, a threat to the security of Canada or to perform its duties and functions under section 16 of the Canadian Security Intelligence Service Act.

The applicant says that the order is necessary to prevent the loss or destruction or ensure the preservation of the information, record, document or thing.

The applicant also says that the Director or a designated employee of the Service intends to apply or has applied for a production order under section 20.4 of that Act or a warrant under section 21 or 22.21 of that Act to obtain the (information, record, document or thing) or under section 23 of that Act to remove a thing.

The reasonable grounds are:

The applicant therefore requests that (name of the person or entity) be ordered to preserve the (specify the information, record, document or thing) that is in their possession or control when they receive the order for 90 days after the day on which the order is made.

Sworn before me on (date), at (place).

(Signature of applicant)

(Signature of commissioner for taking oaths)

(Court File No.)

FEDERAL COURT

IN THE MATTER OF an application by (Name) for a preservation order under section (12 or 16) and subsection 20.3(2) of the Canadian Security Intelligence Service Act, R.S.C. 1985, c. C-23

AND IN THE MATTER OF (Subject)

To (name of person or entity), of :

Whereas I am satisfied by information on oath of (name of Director or designated employee), of ,

• (a) that there are reasonable grounds to suspect that (specify the information, record, document or thing) is in your possession or control and will assist the Canadian Security Intelligence Service to investigate, within or outside Canada, a threat to the security of Canada or to perform its duties and functions under section 16 of the Canadian Security Intelligence Service Act;

• (b) that the order is necessary to prevent the loss or destruction or ensure the preservation of the information, record, document or thing; and

• (c) that the Director or a designated employee of the Service intends to apply or has applied for a production order under section 20.4 of that Act or a warrant under section 21 or 22.21 of that Act to obtain the (information, record, document or thing) or under section 23 of that Act to remove a thing.

Therefore, you are required to preserve the (specify the information, record, document or thing) that is in your possession or control when you receive this order until (insert date) unless, before that date, the (specify the information, record, document or thing) is obtained under a production order made under section 20.4 of that Act or a warrant issued under section 21 or 22.21 of that Act or a thing is removed in accordance with a warrant issued under 23 of that Act.

You are required to destroy the (specify the information, record, document or thing) that would not be retained in the ordinary course of business, (and, if applicable, and any document that is prepared for the purpose of preserving the information, record, document or thing) in accordance with section 20.8 of that Act. If you contravene that provision without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of judge)

(Court File No.)

FEDERAL COURT

IN THE MATTER OF an application by (Name) for a production order under section (12 or 16) and subsection 20.4(2) of the Canadian Security Intelligence Service Act, R.S.C. 1985, c. C-23

AND IN THE MATTER OF (Subject)

This is the information of (name of Director or designated employee), of (“the applicant”).

The applicant says that they have reasonable grounds to believe that (specify the information, record or document) is in the possession or control of (name of the person or entity) and that it will assist the Canadian Security Intelligence Service to investigate, within or outside Canada, a threat to the security of Canada or to perform its duties and functions under section 16 of the Canadian Security Intelligence Service Act.

The applicant says that they have obtained the approval of the Minister of Public Safety and Emergency Preparedness to make this application.

The reasonable grounds are:

The applicant therefore requests that (name of the person or entity) be ordered to produce (specify the information, record or document) that is in their possession or control when they receive the order.

Sworn before me on (date), at (place).

(Signature of applicant)

(Signature of commissioner for taking oaths)

(Court File No.)

FEDERAL COURT

IN THE MATTER OF an application by (Name) for a production order under section (12 or 16) and subsection 20.4(2) of the Canadian Security Intelligence Service Act, R.S.C. 1985, c. C-23

AND IN THE MATTER OF (Subject)

To (name of person or entity), of :

Whereas I am satisfied by information on oath of (name of Director or designated employee), of , that there are reasonable grounds to believe that (specify the information, record or document) is in your possession or control and that it will assist the Canadian Security Intelligence Service to investigate, within or outside Canada, a threat to the security of Canada or to perform its duties and functions under section 16 of the Canadian Security Intelligence Service Act.

Therefore, you are ordered to produce (specify the information, record or document) that is in your possession or control when you receive this order.

The (specify the information, record or document) must be produced to the Director or an employee of the Service in accordance with that person’s instructions, within (time) and in (form).

You have the right to apply to revoke or vary this order in accordance with section 20.5 of that Act.

Dated (date), at (place).

(Signature of judge)

(Court File No. — to match Production Order)

FEDERAL COURT

IN THE MATTER OF an application by (Name) for the revocation or variation of a production order under section 20.5 of the Canadian Security Intelligence Service Act, R.S.C. 1985, c. C-23

NOTICE

This is a notice that (name of person or entity named in the order) (“the applicant”) intends to apply to the Federal Court for the revocation or variation of the production order made on (date) and served on the applicant on (date).

A copy of this notice has been provided to an employee of the Canadian Security Intelligence Service on (date).

The applicant intends to file the application for revocation or variation on or before (date), the date by which the applicant must comply with the production order.

Dated (date), at (place).

(Signature of applicant)