Criminal Code

Canada,

Province of

(territorial division)

• 1 Identification

  Surname: Given name(s):

  Date of Birth:

• 2 Contact Information

  

• 3 Alleged Offence

  You are alleged to have committed (set out briefly the substance of the offence, including any failure referred to in section 496, that the accused is alleged to have committed).

  • □ (Check if applicable) No new charges are being laid against you at this time but you are required to appear at a judicial referral hearing under section 523.1 for a failure under section 496.

• 4 Conditions

  You must attend court as indicated below, and afterwards as required by the court:

  Date:

  Time:

  Court number:

  Court address:

• 5 Appearance for the purposes of the Identification of Criminals Act (if applicable)

  • □ You are required to appear on (date) at (hour) at (place) for the purposes of the Identification of Criminals Act.

• 6 Consequence for non-compliance

  You are warned that,

  (a) in the case where charges have been laid against you, unless you have a lawful excuse, you commit an offence under subsection 145(3) of the Criminal Code if you fail to appear for the purposes of the Identification of Criminals Act or to attend court, as required in this appearance notice;

  (b) in the case where no charges have been laid against you and you fail to appear at a judicial referral hearing under section 523.1, as required in this appearance notice, charges may be laid against you for the alleged offence described in item 3 of this notice.

  If you commit an offence under subsection 145(3) of the Criminal Code, a warrant for your arrest may be issued (section 512 or 512.2 of the Criminal Code) and you may be liable to a fine or to imprisonment, or to both.

  It is not a lawful excuse to an offence under subsection 145(3) of the Criminal Code that this appearance notice does not accurately describe the offence that you are alleged to have committed (subsection 145(6) of the Criminal Code).

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

• 7 Signatures

  ACCUSED:

  I understand the contents of this appearance notice and agree to comply with it.

  Signed on (date), at (place).

  

  (Signature of accused)

  PEACE OFFICER:

  Signed on (date), at (place).

  

  (Signature of peace officer)

  

  (Name of the peace officer)