Criminal Code

Canada,

Province of ,

(territorial division).

To the peace officers in the (territorial division):

Whereas A.B. of , hereinafter called the accused, has been charged that (set out offence as in the information);

And Whereas E.F. of , hereinafter called the witness, attending before me to give evidence for (the prosecution or the defence) concerning the charge against the accused (refused to be sworn or being duly sworn as a witness refused to answer certain questions concerning the charge that were put to him or refused or neglected to produce the following writings, namely or refused to sign his deposition) having been ordered to do so, without offering any just excuse for such refusal or neglect;

This is therefore to command you, in Her Majesty’s name, to arrest, if necessary, and take the witness and convey him safely to the prison at , and there deliver him to the keeper thereof, together with the following precept:

I do hereby command you, the said keeper, to receive the said witness into your custody in the said prison and safely keep him there for the term of days, unless he sooner consents to do what was required of him, and for so doing this is a sufficient warrant.

Dated this day of A.D. , at .

A Justice of the Peace in and for