Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

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), that the identification of a device or person involved in the transmission of (specify the communication) will assist in the investigation of the offence and that one or more persons whose identity was unknown when the application was made have possession or control of (specify the transmission data) that will enable that identification;

Therefore, on being served with this order in accordance with subsection 487.015(4) of the Criminal Code, you are ordered to prepare and produce a document containing (specify the transmission data) that is in your possession or control when you are served with this order.

The document must be produced to (name of peace officer or public officer) as soon as feasible at (place) in (form).

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)

Served on (name of person) on (date), at (place).

(Signature of peace officer or public officer)

(Signature of person served)