Sch. 2 (5) If any proceedings are taken against you in respect of any offence that you have asked to have taken into account your admission of that offence cannot be used as evidence against you in those proceedings. Signature of (police or officer) (Associate or (Crown or (Director Crown Prosecutor) Prosecutor) of Public Prosecutions) 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) PART C Place where offence Date of Description of offence Number committed offence (with particulars) 1 2 3 4 etc.
(5) If any proceedings are taken against you in respect of any offence that you have asked to have taken into account your admission of that offence cannot be used as evidence against you in those proceedings. Signature of (police officer) or (Associate Crown Prosecutor) or (Crown Prosecutor) or (Director of Public Prosecutions) 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 PART C Number Place where offence committed Date of offence Description of offence (with particulars) 1 2 3 4 etc.
91-49a166.docx