To the Synod of the Protestant Reformed Churches, to convene __________________, 20______, at ___________________________________
Classis ______________ of the Protestant Reformed Churches has appointed the brethren:
| MINISTERS | ELDERS | ||
|---|---|---|---|
| Primi | Secundi | Primi | Secundi |
| ______________ | ______________ | ______________ | ______________ |
| ______________ | ______________ | ______________ | ______________ |
| ______________ | ______________ | ______________ | ______________ |
| ______________ | ______________ | ______________ | ______________ |
| ______________ | ______________ | ______________ | ______________ |
as delegates to represent said classis at the meeting of synod above referred to.
We hereby instruct and authorize them to take part in all the deliberations and transactions of synod regarding all matters legally coming before the meeting and transacted in agreement with the Word of God according to the conception of it embodied in the doctrinal standards of the Protestant Reformed Churches, as well as in harmony with our Church Order.
By order of the classis,
________________, President
_______________, Clerk
(Cf. Acts of Synod, 1941, Art. 81; Acts of Synod, 1942, Arts. 26, 34, Suppl. I, p. XI.)