With my heart full of the most sincere veneration, I prostrate myself before you, O Mother, to ask you to obtain for me the grace to fulfill the duties of my state in life with faithfulness and constancy.
[Here mention your request]
Our Father, Hail Mary, Glory Be.
Hail and blessed be the hour and moment in which the Son of God was born of the most pure Virgin Mary, at midnight, in Bethlehem, in piercing cold. In that hour, vouchsafe, O my God! to hear my prayer and grant my desires, through the merits of Our Saviour Jesus Christ, and of His Blessed Mother. Amen. (15x)