Subject: Application for payment-free months

Debtor: [FIRST NAME LAST NAME], [DATE OF BIRTH]

I request a payment-free month / payment-free months for [MONTH(S) YEAR].

The garnishment of my pay/pension has continued without interruption since
[MONTH/YEAR]. The grounds for my request are: [CHOOSE AND COMPLETE: a
necessary purchase (what it is and a cost estimate) / healthcare costs / my
housing and living costs are high relative to what is left after garnishment
/ another special reason].

Attached: [LIST THE ATTACHMENTS].

I request a written decision on the matter.

[DATE]
[NAME, PHONE NUMBER]