Jeofrey Dalwidao writes a letter to the Provincial Engineering Office Personnel Multi-Purpose Cooperative requesting financial assistance for medical expenses. He was recently hospitalized for chronic calculous cholecystitis and underwent surgery to remove his gallbladder. As an active cooperative member recovering at home with his family, he is facing a large financial gap and tight budget. He provides documentation of his medical records and hospital bill, thanking them in advance for considering his request.

1. FINANCIAL
ASSISTANCE LETTER
SAMPLE
Sit Dolor Amet

2. DATE
◦ NOVEMBER 24, 2021

3. ADDRESSEE
◦ PROVINCIAL ENGINEERING OFFICE
◦ PERSONNEL MULTI-PURPOSE
◦ COOPERATIVE (PEOPMPC)
◦ Capitol Hills, Bulanao, Tabuk City

4. SALUTATION
◦ FINANCIAL AID FOR MEDICAL EXPENSES LETTER
◦ To Whom It May Concern:

5. GREETINGS, IN GENERAL
◦
◦ Christian Greetings!
◦ I hope you are doing well.

6. BODY
◦ I am JEOFREY DALWIDAO, an active member of this cooperative. On November 17, 2021, I
was rushed at St. Peter Claver Hospital, Tabuk City, Kalinga due to severe stomach pain. On
that same day, the doctor recommended that I be confined thereat. I was diagnosed with
CHRONIC CALCULOUS CHOLECYSTITIS which is the swelling and irritation of the
gallbladder. Thus, the doctor performed Laparoscopic cholecystectomy to remove the said
infected gallbladder. Fortunately, the operation was a success. I was discharged on November
19, 2021. I am now currently recovering at home with the care and comfort of my family.

7. CONTINUATION
◦ In light of the foregoing and considering that this cooperative has social programs which aims
to extend assistance to members who are in need of help, I humbly seek your financial
assistance for my hospital and medical expenses during the time I was confined at St. Peter
Claver Hospital. My family and I are still facing a large financial gap and on a tight budget.

8. CONTINUATION
◦ I have enclosed a copy of my medical records and statement of account regarding my
hospitalization.

9. ADDDITIONAL DOCUMENTS ATTACH
◦ ATTACH DOCUMENTS NEEDED

10. CLOSING REMARKS
◦ Thank you for accommodating my request letter. I will anxiously be waiting for your reply.

11. SALUTATION
◦ Yours sincerely,

12. NAME OF WRITER OR MAKER OF THE
LETTER
◦ JEOFREY DALWIDAO

13. SAMPLE FORM
◦ NOVEMBER 24, 2021
◦ PROVINCIAL ENGINEERING OFFICE
◦ PERSONNEL MULTI-PURPOSE
◦ COOPERATIVE (PEOPMPC)
◦ Capitol Hills, Bulanao, Tabuk City
◦ FINANCIAL AID FOR MEDICAL EXPENSES LETTER
◦ To Whom It May Concern:
◦ Christian Greetings!
◦ I hope you are doing well.
◦ I am JEOFREY DALWIDAO, an active member of this cooperative. On November 17, 2021, I was rushed at St. Peter Claver Hospital, Tabuk City, Kalinga due to severe stomach pain. On
that same day, the doctor recommended that I be confined thereat. I was diagnosed with CHRONIC CALCULOUS CHOLECYSTITIS which is the swelling and irritation of the
gallbladder. Thus, the doctor performed Laparoscopic cholecystectomy to remove the said infected gallbladder. Fortunately, the operation was a success. I was discharged on November 19,
2021. I am now currently recovering at home with the care and comfort of my family.
◦ In light of the foregoing and considering that this cooperative has social programs which aims to extend assistance to members who are in need of help, I humbly seek your financial
assistance for my hospital and medical expenses during the time I was confined at St. Peter Claver Hospital. My family and I are still facing a large financial gap and on a tight budget.
◦ I have enclosed a copy of my medical records and statement of account regarding my hospitalization.
◦ Thank you for accommodating my request letter. I will anxiously be waiting for your reply.
◦ Yours sincerely,
◦ JEOFREY DALWIDAO

14. NOTE
◦ FINANCIAL LETTER CAN BE MADE IN DIFFFERENT FORMS, YOU CAN SITE
WHATEVER PURPOSE AND REASONS!

15. THAT’S ALL
◦ THANK YOU FOR SHARING

16. THE END………………