Court File No.___________

PROVINCIAL COURT
(SPECIFY COURT LOCATION) 
(Criminal Division)

BETWEEN:

HER MAJESTY THE QUEEN

-and-

(SPECIFY NAME OF ACCUSED)


DESIGNATION OF COUNSEL
(s. 650.01 CC)
       I, (name of accused) of (address of accused) state that my lawyer is (lawyer’s name, address and phone number).
       I have asked my lawyer to represent me, appear for me and provide legal services for me on the following charges:
 InformationCharge(s)Date of  Number(s)(in Words)Offence(s) 1. 2.        I understand my lawyer cannot appear for me in my absence on any other charges except those listed above, unless I sign a further Designation of Counsel form for those charges.
       I understand that I MUST attend Court in person for my trial if I decide to enter a plea of not guilty or on the day of any guilty plea for any of my charges, and on any day when I will be sentenced (unless the Judge gives permission for me to be absent); and on any day the Judge orders me to attend Court.
       I also understand that I MUST keep in touch with my lawyer until these charges are dealt with in Court. This means I must tell my lawyer IMMEDIATELY if I change my address or telephone number and I will make sure that my lawyer always has a way to contact me. I have been given a copy of this Designation of Counsel.
Dated this _____ day of ______________, 20___ at _________________.



Signature of Accused Signature of Lawyer (Designated Counsel)
 I certify that this document has been filed
with the Court, together with
the Information(s) to which it relates.
Staff Justice of the Peace_______________________________________
Dated this _____ day of ______________, 20___ at _________________.