Criminal Code

To A.B., of , (occupation), (address in Canada), (date of birth), (gender):

Because, on (date), you were convicted of or found not criminally responsible on account of mental disorder for an offence (or offences) in (location of offence(s)) that the Attorney General of the province, or the minister of justice of the territory, has identified as being equivalent to (description of offence(s)) under (applicable provision(s) of theCriminal Code), a designated offence (or designated offences) as defined in subsection 490.011(1) of the Criminal Code;

You are provided with this to inform you 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 the day on which you were sentenced or found not criminally responsible on account of mental disorder for the offence (or if paragraph 490.02904(3)(c) or (d) of the Criminal Code applies, for life because you were convicted of or found not criminally responsible on account of mental disorder for (description of offence(s)) under (applicable designated offence provision(s) of theCriminal Code), a designated offence (or designated offences) within the meaning of subsection 490.011(1) of the Criminal Code) or for any shorter period determined under subsection 490.02904(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 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 the decision of that court.

• 7 You have the right to apply to a court to terminate the obligation to comply with the Sex Offender Information Registration Act and the right to appeal the decision of that court.

• 8 If you are found to have not complied with the Sex Offender Information Registration Act, 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.

Served on (date).

For administrative use only:

Sentence imposed or verdict of not criminally responsible on account of mental disorder rendered on (date).