In the Supreme Court of Newfoundland and Labrador
CR FORM 3.02

In the matter of a requested transfer
of this indictment from Newfoundland and Labrador
to _________________________________

Supreme Court File #:__________________CR

BETWEEN: 

HIS MAJESTY THE KING  v. ________________________________________________
								(name of accused)

CONSENT TO TRANSFER 
I, ______________________________________, hereby request that this indictment be 
	(name of accused)
transferred to _________________________________________________________________ 
(name and address of court, e.g. Supreme Court of British Columbia, 800 Smithe Street, Vancouver, BC, V6Z 2E1)
____________________________________________________________________________________________________________________________________________________________
for disposition.  
I undertake, in accordance with section 478(3) of the Criminal Code, R.S.C. 1985, c. C-46, to plead guilty to the offence(s) named in the indictment in the court to which the matter will be transferred.
I consent to the transfer of this indictment. 

DATED this ________ day of _________________________, 20___. 

_______________________________________
(signature of accused) 
Address: _______________________________
_______________________________________
Tel: ___________________________________  
Fax: __________________________________
On behalf of the Attorney General of __________________________________, I consent to the 
					(specify either Newfoundland and Labrador or Canada)

transfer of this matter to the above named jurisdiction.

DATED this ________ day of _________________________, 20___. 

_______________________________________
(signature of prosecutor) 
Address: _______________________________
_______________________________________
Tel: ___________________________________  
Fax: ___________________________________