In the Magistrate's Court for the District/Region of ...........................................................

held at ......................................................... Case No. .................................. of 20.........

In the matter between

..................................................................................................................... Plaintiff

and

................................................................................................................. Defendant

The plaintiff hereby withdraws the above-mentioned action and consents to pay the defendant's taxed costs.

Dated at .................................... this ............................ day of ............................, 20.......,

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

Plaintiff/Plaintiff's Attorney

To: ................................................................

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

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

and: The Registrar/Clerk of the Court,

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