Simply replace the unfilled areas such as "" and "[date]" with your information.
Dear [manager's name],
I'm writing to discuss my accomplishments with this organization, and in turn my remuneration.
As you know, I've been earning [amount] for [length of time]. I feel it's a reasonable time to ask for a review. Specifically, I wanted to discuss my recent accomplishments, which include the following:
[list of accomplishments. use bullets. things to mention are specific benefits to the company, i.e. increasing sales, efficiency or the speed at which tasks are done.]
Thank you for your attention in this regard. Please let me know when it would be convenient to meet face-to-face.