Provincial Offences Act forms


The forms located in the table below are for informational purposes only. They cannot be filled in electronically, and you should not bring them to court.

WARNING: Any forms shaded in grey in the table below have not yet come into force. Do not use them prior to their effective date, which is listed in the table below. Until the effective date, only use the current version of the form, which appears unshaded in the table below.

Form 10.1, 10.2, 10.3 may be used instead of Form 10 in the Regional Municipality of York.


Provincial Offences Act forms
Form Number Form Title Version Date Effective Date HTML/PDF Form MS Word Form
1 Certificate of Offence Nov. 2, 2011 March 31, 2012 POA-0847-rev1111.doc
2 Red Light Camera Certificate of Offence March 15, 2014 July 1, 2014 POA-0816-rev0314-web.doc
2.1 Fail to Stop for a School Bus - Owner Liability - Certificate of Offence July 6, 2016 July 21, 2016 poa-0862-rev0616-a.doc
3 Offence Notice March 15, 2014 July 1, 2014 POA-0848-rev0314-web.doc
4 Offence Notice Nov. 2, 2011 March 31, 2012 POA-0849-rev1111.doc
5 Red Light Camera System Offence Notice March 15, 2014 July 1, 2014 POA-0818-rev0314-web.doc
5.1 Fail to Stop for a School Bus - Owner Liability - Offence Notice July 6, 2016 July 21, 2016 poa-0863-rev0616-a.doc
6 Red Light Camera System Offence Notice Nov. 2, 2011 March 31, 2012 POA-0850-rev1111.doc
6.1 Fail to Stop for a School Bus - Owner Liability - Offence Notice July 6, 2016 July 21, 2016 poa-0864-rev0616-a.doc
7 Summons March 17, 2011 March 31, 2012 POA-0861-rev0311.doc
7.1 Early Resolution Meeting Notice (in person) Nov. 2, 2011 March 31, 2012 POA-Form7-1-IBR-rev1111.doc
7.2 Early Resolution Meeting Notice (by electronic method) Nov. 2, 2011 March 31, 2012 poa-form7-2-ibr_rev1111.doc
7.3 Early Resolution Outcome Nov. 2, 2011 March 31, 2012 POA-Form7-3-IBR-rev1111.doc
8 Notice of Intention to Appear March 15, 2014 July 1, 2014 POA-0813-rev0314-web.doc
9 Notice of Trial March 15, 2014 July 1, 2014 POA-0814-rev0314-web.doc
10 Notice of Fine and Due Date Nov. 2, 2011 March 31, 2012 POA-0854-rev1111.doc
10 Notice of Fine and Due Date Jan. 19, 2018 April 11, 2018 poa-0854-nfdd-rev0118-web.pdf poa-0854-nfdd-rev0118-web.doc
10.1 Notice of Fine and Due Date Jan. 19, 2018 April 11, 2018 poa-0854-nfdd-form-10-1-rev0218-web.doc
10.2 Notice of Fine and Due Date Jan. 19, 2018 April 11, 2018 poa-0854-nfdd-form-10-2-rev0218-web.doc
10.3 Notice of Fine and Due Date Jan. 19, 2018 April 11, 2018 poa-0854-nfdd-form-10-3-rev0218-web.doc
11 Certificate of Parking Infraction March 17, 2011 March 31, 2012 POA-0855-rev0311.doc
12 Parking Infraction Notice March 15, 2014 July 1, 2014 POA-0856-rev0314-web.doc
13 Parking Infraction Notice March 17, 2011 March 31, 2012 POA-0857-rev0311.doc
14 Notice of Impending Conviction March 15, 2014 July 1, 2014 POA-0858-rev0314-web.doc
15 Notice of Impending Conviction March 17, 2011 March 31, 2012 POA-0812-rev0311.doc
16 Certificate Requesting Conviction March 17, 2011 March 31, 2012 POA-0803-rev0311.doc