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Sample Letter

Send the Debt and Mental Health Evidence Form (DMHEF) to your creditors (sole name)

Use this letter to send the completed Debt and Mental Health Evidence Form (DMHEF) to your creditors.

You can find information about how to use this letter in our Instructions for using the Debt and Mental Health Evidence Form (DMHEF).

  • Fill in your contact details, account number and any extra information you want to include in the grey shaded areas.
  • Today’s date will be added automatically.
  • Sign each letter.

Letter in joint names

You can choose to send a letter in your own name or in joint names. You may have a debt in joint names, or want to write to your creditors together because you have worked out a joint budget.

Change to joint version
You need to include the organisation name.
Name of the organisation you are writing toInclude the name of the person or creditor you are writing to.
You need to include their address.
Their address line 1Make sure you include the full address for the person or organisation. Don't forget the post code.
Their address line 2
Their address line 3
You need to include their postcode.
Their postcodeDon't forget their postcode.
You need to include your address.
Your address line 1Make sure you include your full address.
Your address line 2
Your address line 3
You need to include your postcode.
Your postcodeDon't forget your postcode.

31st March 2023

Date
Dear Sir/Madam
Account No:
This field is required.
Your account or reference numberYou will find your account or reference number on any paperwork from your creditor.
I enclose a copy of my completed Debt and Mental Health Evidence Form (DMHEF) and consent form.
As you will see from the DMHEF, my mental health condition is seriously affecting my ability to manage my money and debts. Please consider my circumstances and use your discretion when collecting on any debt that I owe.
I would like you to
This field is required.
Include a paragraph outlining any special circumstances that you would like the creditor to consider, such as how to contact you. You can also refer to any guidelines that the creditor should follow
I look forward to hearing from you.
Yours faithfully
You need to include your name(s).
Include your full name