Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

To A.B., of , (office or occupation):

Whereas, it appears on the oath of C.D., of , that there are reasonable grounds for believing that E.F., of , has committed or benefited from the commission of the offence of and that the information or documents (describe information or documents) are likely to be of substantial value to an investigation of that offence or a related matter; and

Whereas there are reasonable grounds for believing that it is in the public interest to allow access to the information or documents, having regard to the benefit likely to accrue to the investigation if the access is obtained;

This is, therefore, to authorize and require you between the hours of (as the judge may direct), during the period commencing on and ending on , to produce all the above-mentioned information and documents to one of the following police officers, namely, (here name police officers) and allow the police officer to remove the information or documents, or to allow the police officer access to the above-mentioned information and documents and to examine them, as the judge directs, subject to the following conditions (state conditions):

Dated this day of A.D. , at .

Signature of judge