Government of Canada / Gouvernement du Canada
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Province of Quebec

Quebec Superior Court

(Criminal Division)

Application of (given names and surname of applicant) made pursuant to section 745.6 of the Criminal CodeAffidavit

I, the undersigned, (given names and surname of applicant), detained at (name and place of institution of detention), Province of blank line, make oath and say as follows:

  • 1 I am the applicant.

  • 2 The facts set out in the attached application are true.

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(Signature of applicant)

Sworn before me this blank line day of the month of blank line, 200blank line, at blank line, Province of blank line

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Commissioner for oaths
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