Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

This is the information of (name of peace officer or public officer), of (“the informant”).

The informant says that they have reasonable grounds to suspect (or, if the application is for an order under section 487.014 or 487.0141 of the Criminal Code, reasonable grounds to believe)

• (a) that an offence has been or will be committed under (specify the provision of the Criminal Code or other Act of Parliament); and

• (b) (if the application is for an order under section 487.014 of the Criminal Code) that (specify the document or data) is in the possession or control of (name of the person) and will afford evidence respecting the commission of the offence.

(or)

• (b) (if the application is for an order under section 487.0141 of the Criminal Code) that (specify the document or data), if it is in the possession or control of (name of the person) on (specify the dates to be specified in the order), will afford evidence respecting the commission of the offence (and if applicable, and that the information contained in all reports made under any of sections 7, 7.1 and 9 of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act during the period the order is to be in effect will afford evidence respecting the commission of the offence).

(or)

• (b) (if the application is for an order under section 487.015 of the Criminal Code) that the identification of a device or person involved in the transmission of (specify the communication) will assist in the investigation of the offence and that (specify the transmission data) that is in the possession or control of one or more persons whose identity is unknown will enable that identification.

(or)

• (b) (if the application is for an order under section 487.016 of the Criminal Code) that (specify the transmission data) is in the possession or control of (name of the person) and will assist in the investigation of the offence.

(or)

• (b) (if the application is for an order under section 487.017 of the Criminal Code) that (specify the tracking data) is in the possession or control of (name of the person) and will assist in the investigation of the offence.

(or)

• (b) (if the application is for an order under section 487.018 of the Criminal Code) that (specify the data) is in the possession or control of (name of the financial institution, person or entity) and will assist in the investigation of the offence.

The reasonable grounds are:

The informant therefore requests

(if the application is for an order under section 487.014 of the Criminal Code) that (name of the person) be ordered to produce a document that is a copy of (specify the document) that is in their possession or control when they receive the order (and/or to prepare and produce a document containing (specify the data) that is in their possession or control when they receive the order).

(or)

(if the application is for an order under section 487.0141 of the Criminal Code) that (name of the person) be ordered to produce a document that is a copy of (specify the document) that is in their possession or control on (specify the dates to be specified in the order) (and/or to prepare and produce a document containing (specify the data) that is in their possession or control on (specify the dates to be specified in the order)) (and if applicable, and that the person be ordered to produce a copy of all reports made under any of sections 7, 7.1 and 9 of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act during the period the order is to be in effect).

(or)

(if the application is for an order under section 487.015 of the Criminal Code) that a person who is served with the order in accordance with subsection 487.015(4) of the Criminal Code be ordered to prepare and produce a document containing (specify the transmission data) that is in their possession or control when they are served with the order.

(or)

(if the application is for an order under section 487.016 of the Criminal Code) that (name of the person) be ordered to prepare and produce a document containing (specify the transmission data) that is in their possession or control when they receive the order.

(or)

(if the application is for an order under section 487.017 of the Criminal Code) that (name of the person) be ordered to prepare and produce a document containing (specify the tracking data) that is in their possession or control when they receive the order.

(or)

(if the application is for an order under section 487.018 of the Criminal Code) that (name of the financial institution, person or entity) be ordered to prepare and produce a document setting out (specify the data) that is in their possession or control when they receive the order.

Sworn before me on (date), at (place).

(Signature of informant)

(Signature of justice or judge)