Ani Nishba (I swear), beshaim Ad---- (in the name of G-d) that until ____________________ [Fill in the end date we decided above]
If I have a fall, which is defined by one of the following things:
Either
(a) I intentionally motzi zera livatala (masturbate) while fully awake (and while not touching my wife)
or
(b) I intentionally obtain in any way adult sexual material of any sort, digital or printed (including magazines, DVDs, etc.)
or
(c) I intentionally go to any websites or web pages, pictures, videos, chats or forums, for the purpose of viewing adult sexual content (including any type of adult oriented images, drawings, videos, audio, or erotic reading material) and I actually viewed or listened to inappropriate content
or
(d) if I initiate contact with - or respond positively to - any woman other than my wife for a sexually related purpose (including by e-mail, chat, webcams, etc.)
or
(e) if I partake of any illicit sexually oriented services of any kind (including calls to adult phone lines, massages)
Then, if ________________________ [Fill in Distraction 1 that we decided above]
Or/And ________________________ [Fill in Distraction 2 that we decided above. This is optional]
Or/And ________________________ [Fill in Distraction 3 that we decided above. This is optional]
within the 90 minutes preceding my fall, then
within the next 36 hours (or other time frame) I will ________________________ [Fill in 'Normal Knas' that we decided above].
for each day (or 3 hour period) in which I fall.
If I did not do any (or all) of these things in the 90 minutes preceding my fall, then
within the next 36 hours (or other time frame) I will ________________________ [Fill in 'Heavy Knas' that we decided above].
Some disclaimers to say immediately after making the shvuah (Toch Kidai Dibur) :
You may also want to add something like this at the end:
If I do not renew this shvuah before it ends, I will keep this very same shvuah for another month. However, if I do renew this shvuah before it ends, I can adjust the time-frame, knasos and conditions of the shvuah to suit my situation better, according to my understanding. The new conditions will apply only from when this current Shavuah ends (obviously). Each time I renew the shvuah for another month, I will be able to make adjustments to the shvuah for the following month. And any time I do NOT renew the shvuah, it will automatically continue with the conditions of the previous month. This cycle should continue for 3(?) months from now, at which point I can decide whether or not to renew the shvuah again at all.
Advanced Tip: If you find a specific situation to be a major stumbling block (for example, if you found a loop-hole in your filter which is tempting you to fall more than anything else) you can use the TaPHSiC shavuah to help you make this particular loop-hole not even an option in your mind, by adding the following words in bold (at the end of the Shavuah above):
If I did not do any (or all) of these things in the 90 minutes preceding my fall,
[Or if I use ‘a given loop-hole’ to fall],
then within the next 36 hours (or other time frame) I will ____________ [Fill in 'Heavy Knas']
By making the consequences of your particular stumbling block into a ‘heavy knas’ regardless of what you did before falling, it makes this particular method of falling no longer an option in your mind.