[Place and date]

Applicant

[Full name]
[Correspondence address]
[Email address or telephone number]

Recipient

[Creditor's full legal name and address]

Repayment schedule change request

Regarding agreement no. [number]

Reasons for the request

I request a change to the repayment schedule because [briefly describe the circumstances affecting your ability to repay].

Proposed repayment arrangement

I propose the following repayment arrangement: [number of instalments, amounts and dates, or a proposed new due date].

Terms of the amendment

Please set out the available arrangement, its full costs, its effect on the total amount payable and the proposed repayment schedule.

Please confirm any agreed terms on a durable medium before they take effect.

This letter is a proposal to discuss changes to the terms and does not confirm that an amendment has been agreed.

Attachments

Attachments: [documents supporting the request, if needed].

[Legible signature]

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