See also "Other Fees" noted below. Complete for ANY non-employee payee receiving payments: Non-Employee Claimant (not a current or former employee).The letter must outline your complaint, the harm you suffered, and how you want the problem resolved. This is called a 30 Day Demand Letter. This article provides a template for a debt settlement proposal letter and explains what a debt settlement letter should contain. I can confirm that I am unable to offer to pay in full what I owe. And I want to offer this as an ex-gratia payment in full and final settlement of the account. Submit this form to the Office of the Comptroller with copies of a non-tort settlement or judgment for review and approval of payment. Fill in your contact details, account number and any extra information you want to include in the grey shaded areas. "Generate a free Debt Validation Letter to ascertain the legitimacy of your debt.