Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

To (name of person), of :

Whereas I am satisfied by information on oath of (name of peace officer or public officer), , that there are reasonable grounds to believe that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) and that (specify the document or data), if it is in your possession or control on any of the dates specified in this order, will afford evidence respecting the commission of the offence (and if applicable, and that the information contained in all reports you make under any of sections 7, 7.1 and 9 of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act during the period this order is in effect will afford evidence respecting the commission of the offence);

Therefore, you are ordered to

produce a document that is a copy of (specify the document) that is in your possession or control on (specify up to six dates)

(and/or)

prepare and produce a document containing (specify the data) that is in your possession or control on (specify up to six dates)

(and if applicable)

produce a copy of all reports you make under any of sections 7, 7.1 and 9 of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act.

The document (and if applicable and the copy of the report) must be produced to (name of peace officer or public officer) within (time) of each of the dates specified in this order at (place) in (form).

This order is subject to the following conditions:

You have the right to apply to revoke or vary this order.

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

Dated (date), at (place).

(Signature of justice or judge)