O. 34A, r 2(1)

*I AM SATISFIED THAT:

As part of an operation or investigation, being conducted by An Garda Síochána concerning an arrestable offence namely ..................... the surveillance authorised and hereinafter set out is necessary:—

*for the purposes of obtaining information as to whether the offence has been committed

*for the purposes of obtaining information as to the circumstances relating to the commission of the offence

*for the purposes of obtaining evidence for the purposes of proceedings in relation to the offence

*I AM SATISFIED THAT:

the surveillance authorised and hereinafter set out is necessary for the purpose of preventing the commission of arrestable offences

*I AM SATISFIED THAT:

the surveillance authorised and hereinafter set out is necessary for the purpose of maintaining the security of the State

AND I AM SATISFIED THAT:

to issue the Authorisation hereinafter set out is justified having regard to the matters referred to in section 4(5) of the Act and all other relevant circumstances and that the surveillance hereinafter set out is

(a) the least intrusive means available, having regard to its objective and other relevant considerations

(b) proportionate to its objectives, having regards to all the circumstances including the likely impact on the rights of any person, and

(c) of a duration that is reasonably required to achieve its objectives.

the Authorisation hereinafter set out is not likely to relate primarily to communications protected by privilege

I CONSIDER that the Authorisation issued herein by me and as hereinafter set out is reasonable

*The said Superior Officer approved the carrying out of surveillance in accordance with subsection (3) of section 7 of the Act and has applied under subsection (4) of section 4 of the Act for said surveillance to be continued and having regard to a copy of the written record of approval under subsection (3) of section 7 of the Act, and to the summary of the results of the surveillance carried out pursuant to that approval produced with said application

I HEREBY ISSUE AN AUTHORISATION under section 5 of the Act for the carrying out of surveillance

(a) by the use of a surveillance device the particulars of the same being

(b) *the person who is to be the subject of the surveillance being

*the place to be the subject of the surveillance being

........................

*the thing to be the subject of the surveillance being

........................

(c) the Superior Officer to whom this Authorisation is issued being the said Superior Officer named above

*(d) the conditions imposed in respect of the surveillance authorised are

........................

as I consider appropriate

(e) The date of expiry of the surveillance being the......day of ................ 20.... which date of expiry I consider reasonable in the circumstances, being not later than three months from the date hereof.

*THIS AUTHORISATION FURTHER AUTHORISES:

*........................ of ............................. the Superior Officer

*........................ of ............................. a member of the Garda Síochána designated by .......................... of ............................. the Superior Officer, accompanied by any other person whom he/she considers necessary, to enter, if necessary by the use of reasonable force, a place, namely, ......................., for the purpose of initiating or carrying out the authorised surveillance, and withdrawing the authorised surveillance device, without the consent of a person who owns or is in charge of the place.

Issued this .... day of .............. 20..

.....................................

Judge of the District Court

To the said Superior Officer,

.........................

of ......................

* Delete any words or paragraphs which are inapplicable