[Place and date]

Sender

[Full name]
[Correspondence address]
[Email address or telephone number for the reply]

Recipient

[Recipient's full legal name]
[Recipient's address]

Loan complaint

Regarding agreement no. [agreement number] dated [agreement date]

I am submitting a complaint concerning the performance of the above agreement or the service provided.

Description of events and concerns

[Describe the events in order, give dates and amounts, and explain what you dispute.]

Requested outcome and reasons

[State your specific request, such as an explanation or a correction of the settlement, and briefly explain your reasons.]

Reply arrangements

Please send your reply [specify the preferred method and correspondence address or email address].

Attachments

[List the copies of documents attached or enter none.]

[Legible signature for a paper letter]