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Dispute Form - Rajesh

Dispute form

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Bilal Siddiqui
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21 views1 page

Dispute Form - Rajesh

Dispute form

Uploaded by

Bilal Siddiqui
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CARDHOLDER DISPUTE FORM

Caro Number !Al 610 IO I 1311 ~l?LI lb lo 16 Ii I kblol ol6 I


lol91, 1212131
Details of disputed transaction(s) shown in my statement dated

S. No. Transac:bon Date (s) Name of Merchant Transaction Amount


1.

2.

3.
4.

I have examined the changes made to my earn account and wish to dispute the aforementioned transaction/s for the
following reason:

e Transaction No._ _ _not recognized. Need more clarification on the following details:
Merchant Name Merchant Location,_ _ _ _Transaction date{s)_ _ _ _ _Transaction amount

El Unauthorize or Not participated in the transaction No. _ __

El Transaction No._ _ _Incomplete / Failed/ Not authorized. Attached transaction slip {Yes/ No) _ __

El Transaction No.._ _ _,has been Duplicated, only one sale was authorized.

19 Incurred one transaction dated_ _ _ _ _at the above mentioned merchant establishment and not incurred the
transaction(s) No._ _ _listed above. Attached a copy of accepted transaction {Yes/ No) _ __

Transaction No._ _ _amount incurred was_ _ _ _but billed for _ _ _ _ _ _ _ __


Attached a copy of the transaction shp for genuine transaction (Yes/ No) _ _

m Service/ Goods relates to Transaction No._ _ _.not received. Expected date of receipt _ _ _ __
Attached a copy of the letter to merchant attempting to resolve the dispute.

Credit voucher for the transaction No._ _ _was issued on_ _ _ _but not processed to the card account.
Attached a copy of credit refund shp / cancellation letter from the merchant establishment.

Transaction No. _ _ _Cancelled recuning Membership/ Subscription. Date of Cancellation _ _ _ __

Transaction No._ _ _ Hotel reservation cancelled on_ _ _ _ _but billed fornno show" charge. The
cancellaoon number 1s _ _ _ __

Transaction No._ _ _ Paid the amount by other means, evidence of payment by Cash/ Cheque/ Credit card/
Others 1s attached. _ __

OtherDisputeReasons: (J:n._Qu:t bo:f:i' 2.ed TlfUn goc~;oo No, 0:637-6'.9


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I hereby affinm that the infonmation furnished above is true tothebest of rnyknowreoge. e._'YC..hQ )1 t I :S Lt ()a tlft., 0 ~I"Zi'?J
My card was in my possession and control at the time of the questioned transaction. •
NameRgje.,sh \/i.stbWO.K~ ~Number O SO /6 2 :S2 7.{,

Io I~ h 12.12131
Kindly e-mail back the completed dispute form from your registered e-mail ID to [email protected]

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