Date: [Date]
To: [Creditor Name]
Address: [Creditor Address]
Re: Hardship Request for Account #[Account Number] (or Reference #[Reference])
1.1 Account Holder Name: [Full Name]
1.2 Phone/Email: [Phone] / [Email]
1.3 Mailing Address: [Address]
2. Purpose of This Letter
2.1 I am writing to explain my current financial hardship and request assistance with my account listed above.
2.2 I want to resolve this matter in good faith and avoid further delinquency if possible.
3. Hardship Explanation
3.1 Reason for Hardship: ☐ Job loss ☐ Reduced hours ☐ Medical expenses ☐ Family emergency ☐ Divorce/separation ☐ Other: [Explain]
3.2 When It Began: [Month/Year].
3.3 Status: ☐ Temporary ☐ Long-term.
3.4 Brief Details (Plain Language):
[2–5 sentences explaining what happened and how it affected your income/expenses.]
4. Requested Assistance
4.1 I am requesting the following assistance (select one or more):
☐ Temporary payment reduction to $[Amount] for [**] months
☐ Payment deferral/forbearance until [Date]
☐ Interest rate reduction to [**]%
☐ Waiver of late fees/penalties (from [Date] to [Date])
☐ A payment plan: $[Amount] per month for [__] months
☐ Settlement offer: I can pay $[Amount] as a lump sum by [Date] to settle the account in full
☐ Other: [Request]
4.2 If you approve a plan, please confirm the terms in writing and provide instructions for payment.
5. What I Can Afford
5.1 Based on my current budget, I can afford: $[Amount] per ☐ month ☐ pay period.
5.2 I expect my financial situation may improve by: [Date/estimate], if applicable.
6. Supporting Documents (Optional)
6.1 I can provide documents supporting my hardship, such as:
-
Proof of income reduction or termination
-
Recent pay stubs or benefit statements
-
Medical bills (summary pages)
-
Bank statements (summary pages)
-
Monthly budget summary
-
Other: [List]
Proof of income reduction or termination
Recent pay stubs or benefit statements
Medical bills (summary pages)
Bank statements (summary pages)
Monthly budget summary
Other: [List]
7.1 You can reach me at [Phone] or [Email].
7.2 I appreciate your consideration and look forward to resolving this account.
Sincerely,
[Your Full Name]
Signatures
Signature: ___________________________
Date: [Date]