Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

This is the information of C.D., of , (occupation), hereinafter called the informant.

The informant says that (if the informant has no personal knowledge state that he believes on reasonable grounds and state the offence).

A Justice of the Peace in and for

Note: The date of birth of the accused may be mentioned on the information or indictment.