Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

To E.F., of , (occupation);

Whereas A.B. has been charged that (state offence as in the information), and it has been made to appear that you are likely to give material evidence for (the prosecution or the defence);

This is therefore to command you to attend before (set out court or justice), on the day of A.D. , at o’clock in the noon at to give evidence concerning the said charge, and to bring with you anything in your possession or under your control that relates to the said charge, and more particularly the following: (specify any documents, objects or other things required).

TAKE NOTE

You are only required to bring the things specified above to the court on the date and at the time indicated, and you are not required to provide the things specified to any person or to discuss their contents with any person unless and until ordered by the court to do so.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, it may be subject to a determination by the court in accordance with sections 278.1 to 278.91 of the Criminal Code as to whether and to what extent it should be produced.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, the production of which is governed by sections 278.1 to 278.91 of the Criminal Code, this subpoena must be accompanied by a copy of an application for the production of the record made pursuant to section 278.3 of the Criminal Code, and you will have an opportunity to make submissions to the court concerning the production of the record.

If anything specified above is a record as defined in section 278.1 of the Criminal Code, the production of which is governed by sections 278.1 to 278.91 of the Criminal Code, you are not required to bring it with you until a determination is made in accordance with those sections as to whether and to what extent it should be produced.

As defined in section 278.1 of the Criminal Code, record means any form of record that contains personal information for which there is a reasonable expectation of privacy and includes, without limiting the generality of the foregoing, medical, psychiatric, therapeutic, counselling, education, employment, child welfare, adoption and social services records, personal journals and diaries, and records containing personal information the production or disclosure of which is protected by any other Act of Parliament or a provincial legislature, but does not include records made by persons responsible for the investigation or prosecution of the offence.

Dated this day of A.D. , at .

Judge, Clerk of the Court, Provincial Court Judge or Justice

(Seal, if required)