四分律刪補隨機羯磨 1.220

1.220

「我某甲，歸依佛、歸依法、歸依僧，（一日一夜、盡形壽）為（一戒一分、五戒滿分）優婆塞。如來、至真、等正覺，是我世尊。」（三授已。）

"I, N.N., take refuge in the Buddha, take refuge in the Dharma, take refuge in the saṃgha, for (one day and one night / the rest of my life) becoming a (one-precept one-portion / five-precept full-portion) upāsaka. The Tathāgata, the Arhat, the Samyaksambuddha is my World-Honoured One." (Conferred three times.)