I, (a)                                  of (b)                                  hereby authorize (c)                                  of (d)                                  to take legal proceedings on my behalf against (e)                                  of (f)                                  and (e)                                  of (f)                                  for the recovery of (g)                                  .

(h) I have not made any express agreement with the said advocate in regard to his remuneration, but will pay him according to the scales in the Civil Procedure Rules.

or

(h) I have made the following express agreement with the said advocate in regard to his remuneration. (Set out the terms of remuneration agreed upon).

(Signed) (i)                                 

N.B.-Where the client giving the retainer is illiterate the following attestation must be made :

" I certify that the contents of this retainer were read out by me to the above-named (j)                                  and agreed to by him and that he thereupon affixed his mark thereto in my presence."

(Signed)                                 

Registrar, Certifying Officer, or two competent witnesses not being advocates' clerks (as the case may be).

(a) State name, and (b) place of abode.

(c) State name, and (d) business address of advocate retained.

(e) Give the name of intended Defendant or Defendants and (f) his or their address.

(g) State subject matter of intended action.

(h) Strike out whichever is not applicable. The client or, where he is illiterate, the witness or witnesses should initial the statement in regard to remuneration which is left as forming part of the retainer.

(i) Signature of client executing the retainer.

(j) Insert name of client giving the retainer.

Note.-The retainer should be stamped as an agreement if it contains any express agreement in regard to the advocate's remuneration.