Government of Canada / Gouvernement du Canada
Symbol of the Government of Canada


Criminal Code

Version of the schedule from 2012-08-09 to 2019-12-17:

FORM 13(Sections 816, 832 and 834)Undertaking by Appellant (Defendant)


Province of blank line,

(territorial division).

I, A.B., of blank line, (occupation), being the appellant against conviction (or against sentence or against an order or by way of stated case) in respect of the following matter (set out the offence, subject-matter of order or question of law) undertake to appear personally at the sittings of the appeal court at which the appeal is to be heard.

(and where applicable)

I also undertake to (insert any conditions that are directed)

  • (a) report at (state times) to (name of peace officer or other person designated);

  • (b) remain within (designated territorial jurisdiction);

  • (c) notify (name of peace officer or other person designated) of any change in my address, employment or occupation;

  • (d) abstain from communicating, directly or indirectly, with (identification of victim, witness or other person) except in accordance with the following conditions: (as the justice or judge specifies);

  • (e) deposit my passport (as the justice or judge directs); and

  • (f) (any other reasonable conditions).

Dated this blank line day of blank line A.D. blank line, at blank line .

(Signature of appellant)

  • R.S., 1985, c. C-46, Form 13
  • 1999, c. 25, s. 26

Date modified: