Sch. 2 Date Signature of accused acknowledging receipt of a copy of this document Date B CERTIFICATE In sentencing for the offence(s) of 1 2 3 this day the court has taken into account the following offences alleged against and admitted by the accused, that is to say the offences numbered on the back of this form. Dated Signature of (Judge) or (Magistrate) C Place where offence Date of Description of offence Number committed offence (with particulars) 1 2 3 4 etc. _______________
Date Signature of accused acknowledging receipt of a copy of this document Date B CERTIFICATE In sentencing for the offence(s) of 1 2 3 this day the court has taken into account the following offences alleged against and admitted by the accused, that is to say the offences numbered on the back of this form. Dated Signature of (Judge) or (Magistrate) Sch. 2 C Number Place where offence committed Date of offence Description of offence (with particulars) 1 2 3 4 etc. _______________
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