In the name of Allah the Beneficent, the Merciful. 

I have written to you O my Master, may His mercy
and blessing be on you, seeking a favour from you.
I have complained to you for what has happened to
me seeking solutions firstly from Allah and then
from you for a matter that has obsessed me. I am
helpless in combating the problem and for that I have
 resorted to seeking help from Allah and from you,
knowing the status you have with Allah. I am
confident that you will help me get the solution to my
problems swiftly and that you will intercede on my behalf.

I am helpless and moreover I am sinful, so help O my master
and present this problem to Allah and I pray to Him that
He will solve this quickly and grant me victory and success
in finding the solution to my problems.

(Write your hajjat here)

am not able to carry or bear with it. Although I am responsible
for the increase of my sins and ignorant about my responsibilities
 ( Wajibats ) from Allah which are given to me. So help me O my
Master peace be upon you during this time of problems and
sorrow present my prayers to Allah before I compensate and before
 my enemies engulfs me, for you have shown me your blessings.
So I pray to Allah for great salvation and near victory with calmness
from fears. For all Allah is most high and does what he wants.

Allah is sufficient for me from the beginning and in my hopes.
Whatever Allah wishes there is no strength nor any power except
in Allah the high, the great.

(When dropping the Ariza in the sea, we normally recite the following
addressing Husayn bin Rawh, the third Naib of the 12th Imam A.S. )

O Husayn bin Rawh, Salamun Alaykum, I bear witness you died in
the path of Allah and ( hence ) you are alive and are sustained by
Allah I am addressing you in your "life"which you lead with Allah
- this is my note and wishes to the Master of the Era (the 12th Imam A.S).  
So please hand it over to him for you are indeed trustworthy.