Cardholder Letter of Dispute Nium (1)

CARDHOLDER'S LETTER OF DISPUTE
CARDHOLDER DETAILS
Cardholder Name: ____________________________________________ Card Number: _______________________________________
Card Account ID: _____________________________________________ Corporate Client : ____________________________________
Cardholder Registered Email Address: ______________________________________
DISPUTED TRANSACTIONS
Transaction Date Merchant Name (as it appears on statement) Transaction Amount ($) Disputed Amount ($)
If you are disputing more than 3 transactions, please attach a copy of your card transaction history & highlight the disputed transactions.
REASONS FOR DISPUTE
Please select only ONE of the following dispute boxes and attach supporting documents. Refer to the Appendix section for
clarification on the required documents and conditions to be met for submission of the dispute reason.
Goods / Services Not Received

Cardholder did not receive the goods/services that were expected on _____________ (DD/MM/YY)
Goods Received but Not As Described/Defective

Cardholder received goods that were not as described or defective and returned it to the merchant on ____________ (DD/MM/YY)
Cancelled Reservation
Cardholder made a hotel/airline/car rental reservation but notified the merchant to cancel reservation on ____________
(DD/MM/YY). Cancellation reference is ____________ (if applicable)
Cancelled Recurring Charge/ Membership/ Subscription

Cardholder has notified the merchant to cancel recurring charge on ____________ (DD/MM/YY) but the account is still being charged
Unauthorized / Unrecognized Transaction(s) *note that your card needs to be blocked

There was no authorization nor participation in the transaction(s) above. The card was (circle one of the following choices):
A. In cardholder’s possession at the time of transaction(s) OR B. Lost or stolen on _____________ (DD/MM/YY)
At least one transaction of $_____________ was authorized at the above merchant, but there was no authorization for other
transaction(s) of $_____________. The card was in cardholder’s possession at the time of other transaction(s).
Incorrect Amount/ Currency

The amount/currency billed to the account was altered from ____________ to ____________
Duplicate Billing
The card was charged more than once for an authorized transaction.
Refund/ Credit Not Processed

A credit amount of $ ____________ was due to be processed to the account on ____________ (DD/MM/YY)
Paid By Other Means (circle one of the following choices)

Cardholder has already paid for the transaction(s) above by cash, other card, cheque or others (please specify) __________________
Others, if none of the above reasons applies: ______________________________________________________________________
To proceed with the dispute resolution process, please submit the signed Cardholder's Letter of Dispute enclosed with the
relevant supporting document(s) within the next 7 calendar days to: [email protected]. Refer to Appendix.
Declaration
I hereby agree that,
- All information provided is true and accurate to the best of my knowledge
- The dispute resolution process may take between 2 to 6 months
- NIUM does not guarantee the successful recovery of disputed amount as the outcome is determined by, but not limited to, the
investigation by merchant’s bank and/or rules & regulations defined by Card Association.
______________________________________ ________________________
Signature Date (DD/MM/YY)
CARDHOLDER'S LETTER OF DISPUTE
APPENDIX
Dispute Reason Condition(s) To Be Met Supporting Documents
Cancelled Recurring Charge/ Cancellation must meet merchant’s Formal cancellation notice given to merchant prior
Membership/Subscription cancellation policy to billing of dispute transaction(s)
Cardholder must attempt to resolve with Proof of resolution attempt with merchant (e.g.
merchant email correspondences)
Cancelled Reservation Cardholder must meet merchant’s Cancellation issued by merchant and proof of
cancellation policy. cancellation (e.g. email confirmation)
Cardholder must attempt to resolve with Proof of resolution attempt with merchant (e.g.
merchant. email correspondences)
Duplicate Billing Duplicate transactions must have same Not required
transaction date, amount and merchant
name as the authorized transaction
Goods Received But Not As Cardholder must return the defective goods Invoice showing description of goods
Described/Defective back to the merchant and attempt to resolve
with merchant to obtain refund A detailed explanation from cardholder on the
defects of goods received
Merchant acknowledgement of returned goods
Tracking number from shipping company of the

returned goods (if applicable)
Proof of resolution attempt with merchant (e.g.

email correspondences)
Goods/Services Not received Cardholder must attempt to resolve with Invoice showing expected delivery date and location
merchant for a refund of goods /services
(Not valid if the Cardholder
cancelled delivery of Proof of delivery agreement (cardholder must wait
goods/services prior to 15 calendar days from date of transaction for
delivery date) delivery if there is no stated date of delivery)
Proof of attempt to resolve with merchant (e.g.

email correspondences)
Proof that merchant is unable to provide

goods/services due to permanent business closure
(if applicable)
Incorrect Amount/Currency Amount/currency on copy on sales draft Invoice showing the correct amount/currency
must be different from amount/currency on agreed by cardholder.
billed statement
Paid by Other Means Transaction amount and merchant must be Proof of payment via other means (e.g. copy of cash
the same on both disputed card, and the receipt, credit card statement, cashed cheque
other payment channel image, valid 3rd party voucher)
If paid to two different merchants, proof

that the payment was passed from one
merchant to another (e.g. payment from a
travel agent to another merchant)
Refund/Credit Not Processed Refund/credit must meet merchant’s terms Credit Transaction Receipt issued by merchant
and conditions. stating card number, date and refund/credit
(Not valid for verbal amount (cardholder must wait 15 calendar days
agreement by merchant) from date of Credit Transaction Receipt before
disputing)
Void transaction receipt/cancellation code by

booking merchant
Unauthorized /Unrecognized Card containing the disputed transactions Not required
Transaction(s) will be blocked

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CARDHOLDER'S LETTER OF DISPUTE

REASONS FOR DISPUTE

Goods / Services Not Received

Goods Received but Not As Described/Defective

Cancelled Recurring Charge/ Membership/ Subscription

Unauthorized / Unrecognized Transaction(s) *note that your card needs to be blocked

Incorrect Amount/ Currency

Refund/ Credit Not Processed

Paid By Other Means (circle one of the following choices)

Others, if none of the above reasons applies: ______________________________________________________________________

Merchant acknowledgement of returned goods

Tracking number from shipping company of the

Proof of resolution attempt with merchant (e.g.

Proof of attempt to resolve with merchant (e.g.

Proof that merchant is unable to provide

If paid to two different merchants, proof

Void transaction receipt/cancellation code by

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