[Your Name]
[Your address Line 1]
[Your town/city]
[Your postcode]	
Basildon Benefits Centre
Post handling site B
Wolverhampton 	 
WV99 1EG	Monday, 25 September 2017	
Dear Sir / Madam,
Mandatory Reconsideration Request - Employment & Support Allowance
Date of birth: 			[your date of birth]
National insurance number: 	[your national insurance number]
Decision date: 			[date on decision letter]
I disagree with the decision because I believe that full account was not taken of my health conditions and in particular, their impact on my ability to perform the following activities:
 [delete any from this list that don’t apply]

•	Moving around
•	Standing & sitting
•	Reaching
•	Picking up & moving things
•	Using my hands
•	Speaking, writing & typing
•	Hearing & reading
•	Getting around safely
•	Controlling my bowels & bladder
•	Staying conscious
•	Learning how to do tasks
•	Awareness of hazards or danger
•	Starting & finishing tasks
•	Coping with change
•	Going out
•	Coping with social situations
•	Behaving appropriately
•	Eating & drinking

Please accept this request outside of the 30 day time limit because:
[write your reasons why it is late. The longer the delay, the more compelling your reasons must be.]
Yours faithfully

[your name]