Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

To (name of person), of :

Because I have reasonable grounds to suspect that the computer data specified below is in your possession or control and that that computer data

will assist in the investigation of an offence that has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament),

(or)

will assist in the investigation of an offence that has been committed under (specify the provision of the law of the foreign state) that is being conducted by a person or authority, (name of person or authority), with responsibility in (specify the name of the foreign state) for the investigation of such offences,

you are required to preserve (specify the computer data) that is in your possession or control when you receive this demand until (insert date) unless, before that date, this demand is revoked or a document that contains that data is obtained under a warrant or an order.

This demand is subject to the following conditions:

If you contravene this demand without lawful excuse, you may be subject to a fine.

You are required to destroy the computer data that would not be retained in the ordinary course of business, and any document that is prepared for the purpose of preserving the computer data, in accordance with section 487.0194 of the Criminal Code. If you contravene that provision without lawful excuse, you may be subject to a fine, to imprisonment or to both.

(Signature of peace officer or public officer)