Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

To A.B., of , (occupation), a person referred to in subsection 490.02(1) of the Criminal Code:

Because, on (insert date(s)), you were convicted of, or found not criminally responsible on account of mental disorder for, (insert description of offence(s)), one or more offences referred to in paragraph (a), (c), (c.1), (d), (d.1) or (e) of the definition designated offence in subsection 490.011(1) of the Criminal Code or in paragraph (a) or (c) of the definition designated offence in section 227 of the National Defence Act, under (insert the applicable offence provision(s)), this is provided to give you notice that you are required to comply with the Sex Offender Information Registration Act.

• 1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(2) of that Act.

• 2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of years after you were sentenced, or found not criminally responsible on account of mental disorder, for the offence (or if paragraph 490.022(3)(c) or (d) of the Criminal Code applies, for life) or for any shorter period set out in subsection 490.022(2) of the Criminal Code.

• 3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

• 4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

• 5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act or, if applicable, the Canadian Forces Provost Marshal, to correct the information.

• 6 You have the right to apply to a court to exempt you from the obligation to comply with the Sex Offender Information Registration Act, and the right to appeal any decision of that court.

• 7 You have the right to apply to a court to terminate the obligation, and the right to appeal any decision of that court.

• 8 If you are found to have contravened the obligation, you may be subject to a fine or imprisonment, or to both.

• 9 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Dated this day of , at .