Surname: Given name(s):
Date of birth:
Phone number(s): (primary) (other)
Other contact information (if any):
Employment or Occupation (if any):
Name and contact information of employer (if any):
2 Financial Promise or Deposit
Pursuant to (provision) of the Criminal Code, I agree to (promise or deposit) the amount of $ , or the other valuable security described here:
I understand that if I fail to comply with any of the conditions listed below, this amount or security may be forfeited.
(List the conditions that have been ordered by the court and indicate the duration for which each condition remains in effect.)
I understand that I may apply to a judge or a justice of the peace to have any condition in this form cancelled or varied.
5 Conditions in effect
I understand that the conditions in this recognizance remain in effect until they are cancelled or changed or until I have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).
PERSON WHO IS GIVING RECOGNIZANCE:
I understand the contents of this form and agree to comply with the conditions that are listed above.
Signed on (date), at (place).(Signature of the person)(Print name)
SURETY (if applicable):
I understand my role and my responsibilities under this recognizance and I agree to act as a surety.
I agree to (promise or deposit) as security to the court the amount of $
I understand that if the person who is giving this recognizance fails to comply with any of the conditions in this recognizance, the money that I have promised or deposited may be forfeited.
Surety Declaration (if applicable)
□ Surety Declaration attached. (Section 515.1 of the Criminal Code.)
□ Surety excepted from providing Surety Declaration. (Subsection 515.1(2) of the Criminal Code.)
Signed on (date), at (place).(Signature of the Surety)(Print name)
JUDGE, PROVINCIAL COURT JUDGE, JUSTICE OR CLERK OF THE COURT:
Signed on (date), at (place).(Signature of the judge, provincial court judge, justice or clerk of the court)(Print name)
List of Conditions
(a) has a surety (sections 462.34, 490.9, 550, 779, 810, 817 and 832 of the Criminal Code);
(b) agrees to keep the peace and be of good behaviour (sections 83.3, 810, 810.01, 810.1 and 810.2 of the Criminal Code);
(c) abstains from possessing a firearm, crossbow, prohibited weapon, restricted weapon, prohibited device, ammunition, prohibited ammunition or explosive substance and surrenders those in their possession and surrenders any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm (sections 83.3, 810, 810.01, 810.1 and 810.2 of the Criminal Code);
(d) participates in a treatment program (sections 810.01, 810.1 and 810.2 of the Criminal Code);
(e) wears an electronic monitoring device (if the Attorney General makes the request) (sections 810.01, 810.1 and 810.2 of the Criminal Code);
(f) remains within a specified geographic area unless written permission to leave that area is obtained from the judge (sections 810.01 and 810.2 of the Criminal Code);
(g) returns to and remains at their place of residence at specified times (sections 810.01, 810.1 and 810.2 of the Criminal Code);
(h) abstains from the consumption of drugs, except in accordance with a medical prescription (sections 810.01, 810.1 and 810.2 of the Criminal Code);
(i) abstains from the consumption of alcohol or of any other intoxicating substance, except in accordance with a medical prescription (sections 810.01, 810.1 and 810.2 of the Criminal Code);
(j) abstains from any contact — including communicating by any means — with a person under the age of 16 years, unless doing so under the supervision of a person whom the judge considers appropriate (section 810.1 of the Criminal Code);
(k) abstains from using the Internet or other digital network, unless doing so in accordance with conditions set by the judge (section 810.1 of the Criminal Code);
(l) abstains from attending a public park or public swimming area where persons under the age of 16 years are present or can reasonably be expected to be present, or a daycare centre, schoolground or playground (section 810.1 of the Criminal Code);
(m) appears personally or by counsel at the sittings of the appeal court at which the appeal is to be heard (sections 817 and 832 of the Criminal Code);
(n) appears in court as required (sections 550, 706 and 707 of the Criminal Code);
(o) in the case where a warrant was issued under section 462.32 of the Criminal Code or a restraint order was made under subsection 462.33(3) of that Act in relation to any property (set out a description of the property and its location), refrains from doing or causing anything to be done that would result, directly or indirectly, in the disappearance, dissipation or reduction in value of the property or otherwise affect the property so that all or a part thereof could not be subject to an order of forfeiture under section 462.37 or 462.38 of that Act or any other provision of that Act or any other Act of Parliament (section 462.34 of the Criminal Code);
(p) agrees to prosecute the writ of certiorari at their own expense, without wilful delay, and, if ordered, to pay to the person in whose favour the conviction, order or other proceeding is affirmed their full costs and charges to be taxed according to the practice of the court where the conviction, order or proceeding is affirmed (section 779 of the Criminal Code);
(q) any other reasonable conditions, including:
– reports at specified times to peace officer or other person designated;
– remains within designated territorial jurisdiction;
– notifies peace officer or other person designated of any change in their address, employment or occupation;
– abstains from communicating, directly or indirectly, with victim, witness or other specified person except in accordance with conditions specified by judge, provincial court judge or justice; and
– deposits all their passports as the judge, provincial court judge or justice directs.
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