Criminal Code (R.S.C., 1985, c. C-46)

Canada

Province of

(territorial division)

I (name of peace officer), (occupation), of in (territorial division), apply for an authorization to take additional samples of bodily substances for forensic DNA analysis.

Whereas samples of bodily substances were taken from (name of offender) for the purpose of forensic DNA analysis under an order made under section 487.051, or an authorization granted under section 487.055, of the Criminal Code (attach a copy of the order or authorization);

And whereas on (day/month/year) it was determined that

• (a) a DNA profile could not be derived from the samples for the following reasons:

• (b) the information or bodily substances required by regulations made under the DNA Identification Act were not transmitted in accordance with the requirements of the regulations or were lost for the following reasons:

Therefore, I request that an authorization be granted under subsection 487.091(1) of the Criminal Code to take from (name of offender) the number of additional samples of bodily substances that is reasonably required for forensic DNA analysis, provided that the person taking the samples is able, by virtue of training or experience, to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and that, if the person taking the samples is not a peace officer, they take them under the direction of a peace officer.

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

(Signature of applicant)