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Transaction Dispute Form 2019

The document provides instructions for disputing credit card transactions. It explains that customers must fill out the dispute form completely, check the category that best describes the dispute, and include any supporting documents. It also notes that disputes must be reported within 60 days and that a temporary credit may be issued pending investigation, which will be resolved within 90 days. The form itself requests customer and transaction details and categories for common dispute reasons like unauthorized charges, incorrect amounts, non-receipt of items, and more.

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Rica Ryx
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
289 views

Transaction Dispute Form 2019

The document provides instructions for disputing credit card transactions. It explains that customers must fill out the dispute form completely, check the category that best describes the dispute, and include any supporting documents. It also notes that disputes must be reported within 60 days and that a temporary credit may be issued pending investigation, which will be resolved within 90 days. The form itself requests customer and transaction details and categories for common dispute reasons like unauthorized charges, incorrect amounts, non-receipt of items, and more.

Uploaded by

Rica Ryx
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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CARDHOLDER TRANSACTION DISPUTE FORM

Instructions:
In order for us to investigate your dispute:
1. The CUSTOMER INFORMATION and TRANSACTION DISPUTE DETAILS should be complete and legibly filled out. Send to:
2. Please check one category which best describes your dispute and enclose all supporting documents.
3.
Fax No.: 702-6881 or 702-6882
4. Your duly filled out signed form must reach us through fax or email within 60 days from posting date. Email Address: [email protected]

CUSTOMER INFORMATION
Customer Name (Last, First, M.I.)

Card No. Email Address

Tel. No. Mobile No. Fax No.

TRANSACTION DISPUTE DETAILS


TRANSACTION AMOUNT TRANSACTION AMOUNT
TRANSACTION DATE POST DATE MERCHANT NAME (Php) (Foreign)

UNAUTHORIZED TRANSACTION CANCELLED MEMBERSHIP / SUBSCRIPTION


I did not authorize or participate in the transaction(s) indicated I have cancelled the subscription / membership / policy
above or authorize anyone to engage in the transaction(s) (encircle one) on ___/___/___ (dd/mm/yy) yet the charge
and my card was in my possession at the time of purchase. was billed to my credit card. Enclose is a proof of my
cancellation with the merchant.

DUPLICATE BILLING INCORRECT AMOUNT


I have been billed more than once for the same transaction. I I made a transaction amounting to _________. However, I
authorized only one charge with this merchant for the
amount of _____________on ____/____/____ (dd/mm/yy). of ____________. Enclosed is the copy of the sales slip.

PAID BY OTHER MEANS UNDISPENSED CASH ADVANCE


I used another form of payment for this transaction(s) (cash, I attempted to withdraw cash thru (name of
check, or other credit card). Enclosed is a copy of the proof bank)___________ ATM located at _______________ (Area,
of payment. City) on ___/___/___ (dd/mm/yy), however no cash was
dispensed. Enclosed is a copy of the ATM Slip.

NON-RECEIPT OF MERCHANDISE REFUND / CREDIT NOT PROCESSED


I ordered the merchandise on ___/___/___ (dd/mm/yy) with I have not received my refund from the merchant. Enclosed is
an expected delivery date on ___/___/___ (dd/mm/yy). a copy of my credit voucher.
Enclosed is a copy of my order form.

DEFECTIVE / RETURNED / NOT AS DESCRIBED MERCHANDISE OTHERS


The item that I purchased did not conform to what was Please provide a complete description of the dispute along
agreed with the merchant or was defective. I returned the with your attempted resolution with the merchant. Enclose
item(s) last ___/___/___ (dd/mm/yy). Enclosed is the proof any documentation that supports your claim.
of return/credit voucher and documentation that supports
my claim.

Important Reminder:
In case you are disputing an airline ticket transaction, please be informed that related travel booking may be placed on hold or
cancelled while investigation is ongoing. Please contact your airline directly.

TERMS AND CONDITIONS


1. Only transactions reported within 60 days from its posting date will be accommodated. Except for dispute on tax refund, card present* and secured** transactions, a temporary credit
will be applied within 5 days upon receipt of the signed transaction dispute form and supporting documentation, as applicable.
2. All transactions reported beyond 60 days from the posting date will no longer be accommodated and will be considered true, accurate and binding upon you.
3. You will be advised of the final disposition via a letter, SMS or call out within 90 calendar days from receipt of the transaction dispute form.
4. If the transaction is proven to be valid, it will be billed back to you inclusive of related finance charges.

*Card Present is a type of transaction in which physical presence of the cardholder was established.
**Secured is an internet transaction authenticated by our 3D Secure Facility.

Signature Over Printed Name Date


Revised as of Nov 2016

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