Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of

(territorial division).

• 1 Identification

  Surname: Given name(s):

  Date of Birth:

• 2 Contact Information

  

• 3 Charge(s)

  (set out briefly the offence in respect of which the accused was charged)

• 4 Financial Obligations

  • □ You do not have any financial obligations under this release order.

  or

  In order for you to be released, the obligations that are indicated below by a check mark must be complied with.

  • □ You promise to pay the amount of if you fail to comply with a condition of this release order.

  • □ You must deposit money in the amount of or other valuable security whose value does not exceed with the clerk of the court.

  • □ The surety (name), born on (date of birth), (promises to pay or deposits) to the court the amount of

• 5 Conditions

  You must comply with the conditions that are indicated below by a check mark.

  • □ You must report to (name or title) at (place) on (date or dates).

  • □ You must remain within the territorial jurisdiction of (province or territory).

  • □ You must notify (name, title and phone number) of any change of your (address, employment or occupation).

  • □ You must not communicate, directly or indirectly, with (victims, witnesses or other persons), except in accordance with the following conditions:

  • □ You must not go to (place) or enter (geographic area), except in accordance with the following conditions:

  • □ You must deposit all your passports with (name or title) at (place) before (date).

  • □ You must not possess a firearm, crossbow, prohibited weapon, restricted weapon, prohibited device, firearm part, ammunition, prohibited ammunition or explosive substance and you must surrender any of them in your possession and any authorization, licence or registration certificate or other document enabling the acquisition or possession of a firearm to (name or title) at (place).

  • □ You must comply with the following conditions (conditions for ensuring the safety and security of any victim of or witness to the alleged offence):

  • □ You must comply with the following conditions:

• 6 Variation

  The conditions of this release order may be varied with the written consent of the prosecutor, yourself and your sureties, if any. In addition, you or the prosecutor may apply to a judge to have any condition in this release order cancelled or changed.

• 7 Conditions in effect

  The conditions indicated by a check mark on this release order (including any obligations imposed on your sureties) remain in effect until they are cancelled or changed or until you have been discharged, sentenced or otherwise detained by the court (sections 763 and 764 of the Criminal Code).

• 8 Consequence for non-compliance

  You are warned that, unless you have a lawful excuse, you commit an offence under section 145 of the Criminal Code if you fail to follow any of the conditions set out in this release order, including if you fail to attend court as required.

  If you commit an offence under section 145 of the Criminal Code, a warrant for your arrest may be issued (sections 512 and 512.3 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

  If you do not comply with this release order or are charged with committing an indictable offence after you have been released, this release order may be cancelled and, as a result, you may be detained in custody (subsection 524(4) of the Criminal Code).

  If you do not comply with this release order, the money or other valuable security promised or deposited by you or your surety could be forfeited (subsection 771(2) of the Criminal Code).

• 9 Signatures

  SURETY: (if applicable)

  I understand my role and my responsibilities under this release order and I agree to act as a surety.

  I agree to (promise or deposit) to the court the amount of money described in section 4 of this release order.

  • □ Surety Declaration is attached (section 515.1 of the Criminal Code).

  • □ Surety is excepted from providing Surety Declaration (subsection 515.1(2) of the Criminal Code).

  Signed on (date), at (place).

  

  (Signature of the surety)

  ACCUSED:

  I understand the contents of this form and agree to comply with the conditions that are indicated by a check mark.

  I understand that I do not have to accept the conditions and that, if I do not accept the conditions, I will be detained.

  Signed on (date), at (place).

  

  (Signature of accused)

  JUDGE, JUSTICE OR CLERK OF THE COURT:

  Signed on (date), at (place).

  

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

  

  (Name of judge or justice who has issued this order)