SOLICITATION LETTER FOR MEDICAL ASSISTANCE

This sample letter intended to help a sick person by requesting medical assistance in your local government office. You can even use this letter to a private company or any association.

Indicate your financial situation with the medical request for your sickness or disease. Including your proof of income monthly as a reference to them and bring the medical records with your valid ids.

Disclaimer: All the information inside the Solicitation Letter For Medical Assistance. The name, location, gender, dates and other information details mentioned below are used for the sample letters only. You’re able to change the details in the sample letter of authorization depends on your current situation, country, and personal details.

Last Updated: July 30, 2019

Solicitation Letter For Medical Assistance




-SAMPLE-

Sarita Joelle M. Olarte
Roxas Avenue, Mahayahay
Iligan, Lanao del Norte

April 29, 2017

Mayor Josef F. Francisco
Office of the Mayor
Dasmariñas City, Cavite
4114

RE: Requesting medical assistance for disease

Dear Mayor Josef F. Francisco,

I would like to request medical assistance with your good heart for purchasing my medication for my diabetes. We have difficulty in our financial situation since I was diagnosed with my diabetes. My specialist Dr. Julian Forrest I. Reoja prescribed medicine to me on April 25, 2017.

I was struggling right now because I cannot buy my daily maintenance in my diabetes. My fixed retirement income is not enough to afford my maintenance medicine because it is too expensive. I appreciate your medical assistance at any cost and its a very big help for me to continue my everyday activities.

I have enclosed my medical records and application form stating all the medicines required that needed every day. Also, I have enclosed my last two bank financial statements and see that the cost of my medicine cannot afford my monthly income.

Thank you for accommodating my request letter. If you have any questions and verification regarding my letter and documents. Please don’t hesitate to reach me at my contact number 0916-123-4567.

I hope for your favorable reply soon.

Sincerely yours,

Sarita Joelle M. Olarte



-FORMAT-

[NAME]
[ADDRESS]

[DATE]

[RECIPIENT NAME]
[LOCAL GOVERNMENT OFFICE]
[ADDRESS]
[ZIPCODE]

RE: Requesting medical assistance for disease

Dear Mayor [RECIPIENT NAME],

I would like to request medical assistance with your good heart for purchasing my medication for my [SICKNESS]. We have difficulty in our financial situation since I was diagnosed with my [SICKNESS]. My specialist Dr. [NAME OF THE DOCTOR] prescribed medicine to me on [DATE].

I was struggling right now because I cannot buy my daily maintenance in my [SICKNESS]. My [REASON] income is not enough to afford my maintenance medicine because it is too expensive. I appreciate your medical assistance at any cost and its a very big help for me to continue my everyday activities.

I have enclosed my medical records and application form stating all the medicines required that needed every day. Also, I have enclosed my [PROOF OF INCOME] and see that the cost of my medicine cannot afford my monthly income.

Thank you for accommodating my request letter. If you have any questions and verification regarding my letter and documents. Please don’t hesitate to reach me at my contact number [CONTACT NUMBER].

I hope for your favorable reply soon.

Sincerely yours,
[SIGNATURE]
[NAME]

Solicitation Letter For Medical Assistance

Solicitation Letter For Medical Assistance Document

 

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