BACK BACK | In the application of (given names and surname of applicant) made pursuant to section 745 of the Criminal Code |
| I, the undersigned, (given names and surname of applicant), detained at (name and place of the institution), in the Province of_____________, make oath and say as follows: |
| 1. I am the applicant. |
| 2. The facts set out in the attached application are true. |
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_____________________ (Signature of applicant) |
| Sworn before me on the_________________________________________,19____________, at ________________________________in the Province of ___________________________. |
| ____________________________ Commissioner for Oaths |
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