[Your Name]
[Your address Line 1]
[Your town/city]
[Your postcode]	
Personal Independence Payment 2
Mail Handling Site A
Wolverhampton
WV98 1AB	Monday, 25 September 2017	
Dear Sir / Madam,
Mandatory Reconsideration Request – Personal Independence Payment
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]

•	Preparing & cooking food
•	Eating & drinking
•	Managing treatments
•	Washing & bathing
•	Managing toilet needs
•	Dressing and undressing
•	Communicating
•	Reading
•	Mixing with other people
•	Making decisions about money
•	Going out
•	Moving around

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]