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

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

In the matter between

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

and

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

Take notice that the plaintiff/defendant hereby abandons the undermentioned claim/exception/defence (as the case may be) set up by him or her in his or her summons/plea/reply (as the case may be).

Particulars: ...............................................................................................................................................

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

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

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

Plaintiff/Plaintiff's Attorney or Defendant/Defendant's Attorney.

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

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

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