To,
The Hospital Manager,
___________ (Name of the Hospital),
___________ (Address)

Date: __/__/____ (Date)

From,
___________ (Name of the patient),
___________ (Address)

Subject: Concession Request

Respected Sir/Madam,

I wish to inform you that, I am __________ (Name) and I come from ___________ (Address).

I have completed a treatment for ____________ (Name of the treatment) on _________ (Date) in your esteemed hospital. I want to share that I am ___________ (below poverty line/have poor financial status/lost job recently/explain your status). I will not be able to pay the full amount of ___________ (Mention the exact amount).

I request a concession in the bill amount so that I can remit the bill from my savings.

I hope you would consider my request genuine and help me out in this difficult time. I will be grateful and in return, I would even suggest your hospital to my acquaintances.

Thanking You,
Yours ____________ (Sincerely/Faithfully),
_____________ (Name),
_____________ (Signature)

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