Form No. 1

Application for Ministerial Review - Miscarriages of Justice

SECTION A - PERSONAL INFORMATION

Name
Alias or Former Name
Address
Date of Birth
RCMP Automated Fingerprint Indentication System No. (if any)
Type of Conviction (Summary or Indictable or Finding of Dangerous Offender or Long-Term Offender
Person Making Application on Applicant's Behalf (if any)
Telephone Number
Repesentative's Address

SECTION B - SUPPORTING INFORMATION

PRE-TRIAL HEARING

Date of Preliminary Inquiry
Court and Its Address
Date of Other Pre-Trial Motions (eg. Bail Hearing, Charter Application, etc.)
Particulars Relating to Motion

TRIAL

Date of Trial
Court and Its Address
Plea:
Names and Addresses of Counsel
Mode of Trial
Date of Conviction
Date of Sentence
Particulars Relating to Motion

COURT OF APPEAL

Date of Appeal Filed
Date of Hearing
Date of Decision
Address of Court

SUPREME COURT OF CANADA

Date of Appeal Filed
Date of Hearing
Date of Decision
Grounds for Application
Add another page if needed
Description of the New Matters of Significance that Support this Application
Add another page if needed

SECTION C - REQUIRED DOCUMENTS (Mandatory)

Applicant's Consent to the Release of Personal Information

PRE-TRIAL

(if unable to provide any of the following, please explain why)

Explanation

TRIAL

Explanation

APPEALS

Explanation

SECTION D - OTHER SUPPORTING EVIDENCE (OPTIONAL)

(Affidavits, letters, photographs, plans, drawings, technical and scientific reports, etc.)