Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

To the peace officers in the said (territorial division) and to the keeper (administrator, warden) of the (prison, hospital or other appropriate place where the accused is detained).

This warrant is issued for the committal of A.B., of , (occupation), hereinafter called the accused.

Whereas the accused has been charged that (set out briefly the offence in respect of which the accused was charged);

And whereas the accused was foundFootnote ^*

• ☐ unfit to stand trial

• ☐ not criminally responsible on account of mental disorder

This is, therefore, to command you, in Her Majesty’s name, to take the accused in custody and convey the accused safely to the (prison, hospital or other appropriate place) at , and there deliver the accused to the keeper (administrator, warden) with the following precept:

You, the keeper (administrator, warden), are therefore directed to receive the accused in your custody in the (prison, hospital or other appropriate place) and to keep the accused safely there until the accused is delivered by due course of law.

The following are the conditions to which the accused shall be subject while in your (prison, hospital or other appropriate place):

The following are the powers regarding the restrictions (and the limits and conditions on those restrictions) on the liberty of the accused that are hereby delegated to you the said keeper (administrator, warden) of the said (prison, hospital or other appropriate place):

• Return to footnote ^*Check applicable option.

Dated (date), at (place).

(Signature of judge, provincial court judge, justice, clerk of the court or chairperson of the review board)