Criminal Code

Canada,

Province of

(territorial division)

• 1 Identification

  Surname: Given name(s):

  Date of birth:

• 2 Contact Information

  

• 3 Charge(s)

  (set out briefly the offence in respect of which the accused was charged)

• 4 Appearance for the purposes of the Identification of Criminals Act

  You are ordered, in Her Majesty’s name, to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act.

• 5 Consequence for non-compliance

  You are warned that, unless you have a lawful excuse, it is an offence under subsection 145(2) of the Criminal Code to fail to appear for the purposes of the Identification of Criminals Act, as required by this order.

  If you commit an offence under subsection 145(2) of the Criminal Code, a warrant for your arrest may be issued (section 512, 512.2 or 512.3 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

  If you do not comply with this order you may be arrested and the release order to which you are subject may be cancelled and, as a result, you may be detained in custody (section 524 of the Criminal Code).

• 6 Signatures

  Signed on (date), at (place).

  (Signature of judge, justice or clerk of the court)

  (Name of the judge or justice)