Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

These are the depositions of X.Y., of , and M.N., of , taken before me, this day of A.D., at , in the presence and hearing of A.B., hereinafter called the accused, who stands charged (state offence as in the information).

X.Y., having been duly sworn, deposes as follows: (insert deposition as nearly as possible in words of witness).

M.N., having been duly sworn, deposes as follows:

I certify that the depositions of X.Y., and M.N., written on the several sheets of paper hereto annexed to which my signature is affixed, were taken in the presence and hearing of the accused (and signed by them respectively, in his presence where they are required to be signed by witness). In witness whereof I have hereto signed my name.

A Justice of the Peace in and for