In the Supreme Court of Newfoundland and Labrador
CR FORM 5.01
Supreme Court File #:__________________CR
BETWEEN: 

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

DESIGNATION OF COUNSEL 

Under section 650.01 of the Criminal Code, I, ________________________________, hereby 									(name of accused)			
appoint: (check and complete only those that apply)

•	the law firm of ____________________________________________________;
(name of law firm)

•	__________________________________________________, my lawyer;
(name of the accused’s lawyer)

•	any other lawyer who acts as an agent so long as he or she is specifically instructed to do so by either the law firm or the lawyer named above, 

to represent me in connection with the proceedings relating to charges of ___________________ ______________________________________________________________________________ ______________________________________________________________________________
______________________________________________________________________________
which occurred on or about ___________________________ .
(date of offence)

I designate my counsel (or counsel acting on his/her behalf) to appear on my behalf:  (choose one)

•	at all proceedings where my attendance is not required by law or the direction of a judge of the Supreme Court of Newfoundland and Labrador, General Division. 

OR

•	on the following date(s): _____________________________________. 

I undertake to remain in communication with my appointed counsel and to appear before the court on any date requested by the court, and I agree that notice of such date to my counsel is notice to me of that date. 

My current address is ____________________________________________________________
and my telephone number is _______________________________. I undertake to advise my appointed counsel if I change either my address or telephone number. 

DATED this ________ day of _________________________, 20___. 
_______________________________________
(signature of accused) 
Address: _______________________________
_______________________________________
Tel: ___________________________________  
Fax: __________________________________

I, ____________________________________________, a barrister and solicitor, hereby accept the appointment of ____________________________________as his/her counsel of record, to fully represent the accused’s interests, in the absence of the accused, in relation to the charges identified above. 

I undertake to fully instruct any other lawyer who may appear in my place in accordance with this designation in relation to all matters in this proceeding to which the appearance relates.

DATED this ________ day of _________________________, 20___. 

_______________________________________
(signature of counsel) 
Address: _______________________________
_______________________________________
Tel: ___________________________________
Fax:  __________________________________