| 1. I, (INSERT GIVEN NAMES, SURNAME AND ANY OTHER NAME USED BY THE APPLICANT), of (NAME AND PLACE OF INSTITUTION WHERE APPLICANT IS IMPRISONED) hereby apply for a reduction in the number of years of my imprisonment without eligibility for parole. |
| 2. I was convicted of the offence of (SPECIFY OFFENCE INCLUDING CRIMINAL CODE SECTION) on (DATE OF CONVICTION) at (PLACE AND PROVINCE OF THE CONVICTION). |
| 3. I was sentenced to (SPECIFY THE NUMBER OF YEARS OF IMPRISONMENT) without eligibility for parole before (SPECIFY THE LENGTH OF TIME) on (DATE OF SENTENCE). |
| 4. I have been incarcerated for a period of______ years for that offence in the following institutions (SPECIFY THE NAME OF EACH INSTITUTION AND THE DATE OF ENTRY THEREIN). |
| 5. The aforesaid period of incarceration includes the time that I spent in custody between the day on which I was arrested and taken into custody for that offence and the day the sentence was imposed. |
| 6. The name of the officer in charge of the institution where I am currently incarcerated is________________________________________________________________________________. |
| 7. In support of my application I am relying on the following grounds (Specify ALL grounds PRECISELY and CONCISELY): |
| 8. The evidence I intend to tender at the hearing of my application includes, but is not limited to, the following: |
| (HERE BRIEFLY OUTLINE THE TYPE OF EVIDENCE THE APPLICANT WILL ADDUCE; FOR EXAMPLE, AFFIDAVIT EVIDENCE, INCLUDING NAMES OF DEPONENTS, TESTIMONY OF WITNESSES; INCLUDE NAMES OF WITNESSES, ORAL EVIDENCE OF APPLICANT) |
| 9. My criminal record is attached and marked as Schedule "A" to this application. |
| 10. My address for service is (INSERT COMPLETE MAILING ADDRESS). |
| 11. (IF APPLICABLE) the name and address of my counsel is: (INSERT COMPLETE NAME AND ADDRESS OF COUNSEL). |
| SWORN BEFORE
ME ON THE ) _______DAY OF ____________) 19_____, AT________________) IN THE PROVINCE OF ) __________________________) |
| ____________________________ (Commissioner for Oaths) |
|
_____________________ (Signature of applicant) |