Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

To (name of person), of :

Whereas I am satisfied by information on oath of (name of peace officer or public officer), of ,

• (a) 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) (or has been committed under (specify the provision of the law of the foreign state)) and that (specify the computer data) is in your possession or control and will assist in the investigation of the offence; and

• (b) that a peace officer or public officer intends to apply or has applied for a warrant or order to obtain a document that contains the computer data (and, if applicable, and that (name of person or authority) is conducting the investigation and has responsibility for the investigation of such offences in (insert the name of the foreign state));

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

This order is subject to the following conditions:

If you contravene this order without lawful excuse, you may be subject to a fine, to imprisonment or to both.

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.

Dated (date), at (place).

(Signature of justice or judge)