[insert landlord name and address]

The Benefits Manager
[insert address of housing benefit department]

[insert date]

Dear Sir or Madam

Reference – Request for revision of Decision and Appeal

Your Ref: [insert hb ref]

I have received your notification of a decision not to pay me as landlord dated [insert date of notification] and the written statement of reasons dated [insert date of written statement of reasons].

I hereby request

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