Employment and Support Allowance

Post handling Site B

Wolverhampton

WV99 1AD

4 January 2017

Dear Sirs

Jane Doe, Date of Birth 01/01/1995, NINO JK112233L

13, No fixed abode, Cwmbran, NP44 2AS

I write to formally request a Mandatory Reconsideration in respect of your decision letter dated the 8 December 2015 for my Employment and Support Allowance (ESA) claim.

It is my opinion that material facts from my Work Capability Assessment by Maximus, which would have been pivotal to any decision, were taken out of context and misreported.

Given the above, the full extent of both my physical and mental/cognitive difficulties is disputed. (BOTH physical & mental, cognitive and intellectual function assessment)

Given the above, the full extent of my mobility difficulties is disputed. (Mobility ONLY)

Given the above, the full extent of my mental/cognitive difficulties is disputed. (mental, cognitive and intellectual function assessment ONLY)

It is my intention to gather additional evidence to substantiate my claim; in that respect I ask that one calendar month be given before any further determination is made on my claim.

I thank you for your time and consideration.

Yours faithfully

Jane Doe