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.


Provincial Offences Act forms
Form Number Form Title Version Date Effective Date HTML/PDF Form MS Word Form
- Important Information on Appearance Methods (version 1) Nov. 1, 2021 Nov. 1, 2021 poa-0872-rev1021-web.pdf poa-0872-rev1021-web.doc
- Important Information Relating to Non-Early Resolution Court Locations (version 1) Nov. 1, 2021 Nov. 1, 2021 poa-0871-rev1021-web.pdf poa-0871-rev1021-web.doc
1 Certificate of Offence May 10, 2021 Nov. 1, 2021 poa-0847-rev0521-web.pdf poa-0847-rev0521-web.doc
2 Red Light Camera Certificate of Offence May 10, 2021 Nov. 1, 2021 poa-0816-rev0521-web.doc
2.1 Fail to Stop for a School Bus - Owner Liability - Certificate of Offence May 10, 2021 Nov. 1, 2021 poa-0862-rev0521-web.doc
2.2 Automated Speed Enforcement System Certificate of Offence May 10, 2021 Nov. 1, 2021 asepoa-0866-rev0521-web.doc
3 Offence Notice May 10, 2021 Nov. 1, 2021 poa-0848-rev0521-web.doc
4 Offence Notice May 10, 2021 Nov. 1, 2021 poa-0849-rev0521-web.doc
5 Red Light Camera System Offence Notice May 10, 2021 Nov. 1, 2021 poa-0818-rev0521-web.doc
5.1 Fail to Stop for a School Bus - Owner Liability - Offence Notice May 10, 2021 Nov. 1, 2021 poa-0863-rev0521-web_.doc
5.2 Automated Speed Enforcement System Offence Notice May 10, 2021 Nov. 1, 2021 asepoa-0867-rev0521-web.doc
6 Red Light Camera System Offence Notice May 10, 2021 Nov. 1, 2021 poa-0850-rev0521-web.doc
6.1 Fail to Stop for a School Bus - Owner Liability - Offence Notice May 10, 2021 Nov. 1, 2021 poa-0864-rev0521-web.doc
6.2 Automated Speed Enforcement System Offence Notice May 10, 2021 Nov. 1, 2021 asepoa-0868-rev0521-web.doc
7 Summons May 10, 2021 Nov. 1, 2021 poa-0861-rev0521-web.doc
7.1 Early Resolution Meeting Notice (in person) May 10, 2021 Nov. 1, 2021 poa-0851-rev0521-web.doc
7.2 Early Resolution Meeting Notice (by electronic method) May 10, 2021 Nov. 1, 2021 poa-0852-rev0521-web.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 May 10, 2021 Nov. 1, 2021 poa-0814-rev0521-web.doc
10 Notice of Fine and Due Date Aug. 3, 2021 Nov. 1, 2021 poa-0854-nfdd-rev0821-web.doc
10.1 Municipal By-Law Parking Infraction - Notice of Fine Aug. 3, 2021 Nov. 1, 2021 poa-0854a-nfdd-rev0821-fil-web.doc
11 Certificate of Parking Infraction March 17, 2011 March 31, 2012 poa-0855-rev0311-web.pdf POA-0855-rev0311.doc
12 Parking Infraction Notice March 15, 2014 July 1, 2014 poa-0856-rev0314-web.pdf POA-0856-rev0314-web.doc
13 Parking Infraction Notice March 17, 2011 March 31, 2012 poa-0857-rev0311-web.pdf POA-0857-rev0311.doc
14 Notice of Impending Conviction March 15, 2014 July 1, 2014 poa-0858-rev0314-web.pdf POA-0858-rev0314-web.doc
15 Notice of Impending Conviction March 17, 2011 March 31, 2012 poa-0812-rev0311-web.pdf POA-0812-rev0311.doc
16 Certificate Requesting Conviction March 17, 2011 March 31, 2012 poa-0803-rev0311-web.pdf poa-0803-rev0311-web.doc