Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division)

To (name of person), of , born on (date of birth):

Because you were previously required to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act under (a summons or an appearance notice or an undertaking or an order) issued on (date) and the measurements, processes and operations referred to in that Act were not completed for exceptional reasons;

You are ordered, in Her Majesty’s name, to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act in relation to (set out briefly the offence in respect of which the accused was charged or the offender has been determined to be guilty).

You are warned that, unless you have a lawful excuse, it is an offence under subsection 145(3) of the Criminal Code to fail to appear for the purposes of the Identification of Criminals Act, as required in this summons.

If you commit an offence under subsection 145(3) of the Criminal Code, a warrant for your arrest may be issued (section 512 or 512.1 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

If you are on interim release and do not comply with this summons or are charged with committing an indictable offence after it has been issued to you, any summons, appearance notice, undertaking or release order to which you are subject may be cancelled and, as a result, you may be detained in custody (section 524 of the Criminal Code).

Signed on (date), at (place).

(Signature of judge, justice or clerk of the court)

(Name of the judge or justice)