Criminal Code (R.S.C., 1985, c. C-46)

Canada,

Province of ,

(territorial division).

To the peace officers in the (territorial division) and to the keeper of the (prison) at :

Whereas A.B., hereinafter called the accused, has been ordered to enter into a recognizance to keep the peace and be of good behaviour, and has (refused or failed) to enter into a recognizance accordingly;

You are hereby commanded, in Her Majesty’s name, to arrest, if necessary, and take the accused and convey him safely to the (prison) at and deliver him to the keeper thereof, together with the following precept:

You, the said keeper, are hereby commanded to receive the accused into your custody in the said prison and imprison him there until he enters into a recognizance as aforesaid or until he is discharged in due course of law.

Dated this day of A.D. , at .

Clerk of the Court, Justice or Provincial Court Judge

(Seal, if required)