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Bpi Dispute Form

The document is a cardholder statement of disputed item form. It requests information from the cardholder such as their name, card number, and details of the disputed transaction including date, amount, and merchant. The cardholder must then select a reason for disputing the transaction, such as not authorizing it or being charged multiple times for one purchase. They can provide additional remarks and must sign to declare the dispute information is true before submitting the form for processing.

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Eldon B. Tenorio
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11K views

Bpi Dispute Form

The document is a cardholder statement of disputed item form. It requests information from the cardholder such as their name, card number, and details of the disputed transaction including date, amount, and merchant. The cardholder must then select a reason for disputing the transaction, such as not authorizing it or being charged multiple times for one purchase. They can provide additional remarks and must sign to declare the dispute information is true before submitting the form for processing.

Uploaded by

Eldon B. Tenorio
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’S STATEMENT OF DISPUTED ITEM

Date : _________________________________________________________
Cardholder’s Name : _________________________________________________________
Compromised Card Number : _________________________________________________________

Posting Date Transaction Date Merchant Name Billing Amount

I have examined the transaction(s) above and dispute the item(s) based on the following reasons
(Please check one)

I certify that neither I nor anyone authorized by me participated in the above transaction(s) and that my
card is in my possession at all times.

I engaged in one transaction from the same merchant location, however, I was charged for more than one
transaction that neither I nor anyone else authorized. I certify that my card was in my possession at the time
of the transaction. (REQUIREMENT: SALES SLIP OF THE VALID TRANSACTION)

Others please specify:

REMARKS:

I hereby declare that all information indicated above is true and that my dispute will only be processed upon
completion of this form.

SIGNATURE: __________________________________________
(Owner of the card where the disputed transaction was posted)

NOTE:
 Please send the accomplished dispute form to [email protected]. You may also follow up by calling
580-0496.
 If cardholder continues to dispute the transaction but transaction was subsequently proven to be valid,
transaction amount plus the fees and other charges incurred by BPI as a result will be charged to the
cardholder.
 Reported disputes can be accommodated within thirty (30) calendar days from the statement date indicated
in the SOA.

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