Waiver Letter For Payment [FREE Sample]

Learn how to write a payment waiver request letter. Use our payment waiver request letter sample as a model for your own.

Waiver Letter for Payment Sample

Your Name
Your Address
City, State, Zip Code


RE: Bank or Loan Account Number

To Whom It May Concern:

This letter is a formal request to have my monthly payments of $150 on my car loan frozen for six months from DATE to DATE. 

I am currently in financial difficulty because of an injury I received in a car accident through no fault of mine. Since I work for minimum wage, I have no resources to maintain my payments.

I will be undergoing physical therapy for the next four months and hope to be able to find a job after that. I have met my loan obligation regularly for the past one year and have every intention of paying it off.

I have enclosed my medical report and doctor’s letter as proof of my condition. If you have any questions, I can be reached at Phone Number or at Email Address.

Thank you for considering my request.


Your Name
List of Enclosures: Medical Reports

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