Date: __/__/____ (Date)

Local Authority
__________ (Address)

Dear Sir/Madam,

I, _______________ (Patient Name), son of/ daughter of/ wife of _______________ residing at _________ (Address).

I am writing this letter to request permission for travel from __________ (One Location) to ______________ (Second location) for ___________ (Reason / office work/ essential service/ cremation). As a result of same my travel plan Cannot be deffered.

I also hereby declare that I have taken all the safety measures as per Government guidelines and in case of any accident/mishappening, I shall be wholly responsible.

Look forward to your kind consideration and approval.

____________ (Name)
____________ (Contact Details)

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