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), of , that there are reasonable grounds to suspect that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament) and that keeping (specify the account) open or active will assist in the investigation of the offence;

Therefore, you are required to

• (a) keep the specified account open or active until (insert date) unless the holder of the account requests that you close or deactivate it or this order is revoked or varied; and

• (b) notify (name of peace officer or public officer) as soon as practicable after the account is closed or deactivated at the request of the holder of the account.

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)