Your First name/Last name

Address

Postal code/ CITY

Banking Mediator

Address

Postal code/ City

Done in [your city], on [specify the date].

Subject: Referral letter

Madam, Sir,

I have been a client of [indicate the name of your bank] since [indicate since when you have been with your bank], and I hold a deposit account No. [indicate your account number] at the branch located in [indicate the location of your bank branch].

I am currently in dispute with my bank. Indeed, [explain your issue and the steps you have taken to resolve it].

Since then, I have sent several letters to my bank branch, copies of which are enclosed. I have also met with the branch manager, but no amicable agreement could be reached.

Consequently, I am seeking your assistance and kindly request that you intervene with [indicate the name of your bank] so that this matter may progress quickly.

While awaiting your reply, please accept, Madam, Sir, the expression of my best regards.

[Your signature]