District No.

THE INFORMATION of ……………..

of ……………

*a member of the Garda Síochána *an officer of Customs and Excise

Who says on oath that-

On the … day of ………. 200… at …. o’clock at …….. in the court (area and) district aforesaid, I seized and detained in accordance with Section 38 of the Criminal Justice Act 1994, as amended by Section 20 of the Proceeds of Crime (Amendment) Act 2005 from one ……… cash in the amount of approximately ……….. (being an amount not less than the sum prescribed by the Minister for Justice, Equality and Law Reform, for the purposes of the said Act, as the prescribed sum) which said cash was being *exported from/*imported into the State.

I had at the time of such seizure and detention and have now reasonable grounds for suspecting that:

* the said ……… was importing or exporting or intended to or was about to import or export the said cash and

* the said cash directly or indirectly represented the proceeds of crime

* the said cash was intended by ……… for use in connection with criminal conduct.

The basis for my so suspecting is as follows:

I believe that the continued detention of the said cash beyond forty eight hours from its seizure and detention is justified

*while its origin or derivation is further investigated

*while consideration is given to the institution (whether in the State or elsewhere) of criminal proceedings against any person for an offence with which the cash is connected.

The basis for my belief is as follows:

And I hereby apply for an order authorising the detention of the said cash for the period of ……… (being a period not exceeding three months) until the … day of ……. 200...

Signed …………….

Informant

SWORN before me this ... day of ........ 20

Signed ………………….

Judge of the District Court

* Delete words inapplicable