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HSBC 161022 - Credit Card Dispute Form

The cardholder dispute form allows the cardholder to dispute transactions on their credit card account. The cardholder can select from a list of dispute reasons including unauthorized transactions, cancelled reservations, receipt of partial payment or defective merchandise. Supporting documentation such as transaction receipts or cancellation records can be enclosed. The cardholder provides their credit card and contact details, signs and dates the form, and returns it to the bank within 14 days to initiate a dispute investigation.

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272 views

HSBC 161022 - Credit Card Dispute Form

The cardholder dispute form allows the cardholder to dispute transactions on their credit card account. The cardholder can select from a list of dispute reasons including unauthorized transactions, cancelled reservations, receipt of partial payment or defective merchandise. Supporting documentation such as transaction receipts or cancellation records can be enclosed. The cardholder provides their credit card and contact details, signs and dates the form, and returns it to the bank within 14 days to initiate a dispute investigation.

Uploaded by

percysmith
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
You are on page 1/ 2

To~ : The Hongkong and Shanghai Banking Corporation Limited lfiiJ:lfiiiiiiiU'Tfim*Rl

Cardholder Dispute and Chargeback Section, Card Centre: 8/F Tower 2 & 3 HSBC Centre, 1 Sham Mong Road, Kowloon
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HSBC CARDHOLDER DISPUTE FORM )II.


Note 11' : Please tick where applicable.

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Credit Card Number 1i ffl -HMlll

Bank Reference Number

Transaction Date
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Merchant Name

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Transaction Amount
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Disputed Amount
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I refer to the above transaction(s) and advise that (Please select the dispute reason listed below.)
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I have neither made nor authorised the above transaction(s). *A:tt~Ul9.\Gllllft!!AilJ;J.L~~.

I did not make any reservation(s) with the merchant. *A~~iaJJiti!li.P'!UHfm .

I made the reservation with the merchant, I cancelled it on _ _ _ _ _ _ __ _ _ with cancellation code _ _ _ _ _ _ _ _ __

I paid the above transaction(s) by *A 8 ffl

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other credit card

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(number ;m!l _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __

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cheque 1<:Jll (number ;m11 _ _ _ _ _ __ _

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A copy of the
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cash receipt
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cheque
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bank statement
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is enclosed.

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The merchant made an addition or transposition error. I enclose the transaction receipt copy in support.
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The transaction amount has been altered from _ _ _ __ _ _ _ __ _ _ _ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ without my


consent. The cardholder copy of the transaction receipt is enclosed.

I have received a credit transaction receipt(s) from the merchant. However, no credit was posted to my card account. A copy of the credit slip
is enclosed. *A~~i!li.Plii~ti<:JlUI:~BJl., ffi.*AI~ffi*~i~i!li.P!':Jl!~ . m~~~ L l!~HfB.!l1~*

The merchandise was to be shipped. I received it and returned it back to the merchant. The merchant did not properly disclose a limited return
policy at the time of transaction and no credit was received. A copy of the relevant document/sis enclosed.
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I have requested for the termination of the service with the merchant on _ _ _ __ _ _ _ _ __ by 0 letter 0 email
A copy of the termination document is enclosed for your action. Please request the merchant to stop further billings.

facsimile.

Page >iO.: 112


CPD278-m (1012 15) FW

I have neither made nor authorised the transactions and will not accept any subsequent transactions posted after the above one.
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I have neither made nor authorised the above transaction (transaction receipt number _ _ __ __ _ _ _ _ _ _ _ _ ). I was still in
possession and control of all valid cards at the time of the transaction. I only authorised the transaction amount of _ _ _ _ _ _ _ _ __
on _ __ _ _ __ __ _ __ _ (transaction receipt number - - - -- - - - - - - - - - ).
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I did engage in the above transaction(s) but

I or my authorised person did not receive the service/merchandise from the merchant. A copy of the order form is enclosed.

I did not receive the requested cash

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I only received part of the cash for the amount of

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The merchandise/service received is not as described as the one I ordered/purchased from the merchant.
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Please specifY how the merchandise is not as described and provide relevant proof to show the difference/defectiveness. !#f.111it'f'Fal.:ZJ8&/6f1Utlllfllj/j.

The order I made was in

in

(state currency, example, CNY). However, the transaction wrongly charged by merchant is
(state currency, example, USD).

Other dispute reason (please specifY in details) : *~mt~

Signature

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Cardholder N arne

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Date S IOl

Contact Telephone Number

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Note: Please sign and return this form to the above address within fourteen days. Should you have any questions, please feel free to contact us on (852) 2288 2533 .
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HSBC CARDHOLDER DISPUTE FORM )IIIUIHT.ff.F~ffl-t~~li:JI~'ili*

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2/2

CPD278-m (101215) FW

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