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    Dispute Form: Transaction Date Merchant Name / ATM Location & Bank Name Transaction Amount Disputed Amount

    Uploaded by

    Sameen Saleem
    This dispute form allows a customer to dispute a transaction on their credit or debit card by providing details of the disputed transaction including date, merchant, and amount as well as a reason for the dispute such as a cash withdrawal not being dispensed from an ATM or goods/services not being received. The customer must declare that the information provided is accurate and acknowledge responsibility for related charges depending on the dispute outcome.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dispute Form: Transaction Date Merchant Name / ATM Location & Bank Name Transaction Amount Disputed Amount

    Uploaded by

    Sameen Saleem
    471 views1 page
    This dispute form allows a customer to dispute a transaction on their credit or debit card by providing details of the disputed transaction including date, merchant, and amount as well as a reason for the dispute such as a cash withdrawal not being dispensed from an ATM or goods/services not being received. The customer must declare that the information provided is accurate and acknowledge responsibility for related charges depending on the dispute outcome.

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    Dispute Form

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    This dispute form allows a customer to dispute a transaction on their credit or debit card by providing details of the disputed transaction including date, merchant, and amount as well as a reason for the dispute such as a cash withdrawal not being dispensed from an ATM or goods/services not being received. The customer must declare that the information provided is accurate and acknowledge responsibility for related charges depending on the dispute outcome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    471 views1 page

    Dispute Form: Transaction Date Merchant Name / ATM Location & Bank Name Transaction Amount Disputed Amount

    Uploaded by

    Sameen Saleem
    This dispute form allows a customer to dispute a transaction on their credit or debit card by providing details of the disputed transaction including date, merchant, and amount as well as a reason for the dispute such as a cash withdrawal not being dispensed from an ATM or goods/services not being received. The customer must declare that the information provided is accurate and acknowledge responsibility for related charges depending on the dispute outcome.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ANNEXURE DC-08

    DISPUTE FORM Date: - -


    (DD/MM/YY)

    Card Number: - - -

    Account Number:

    Customer /Card Holder Name:

    Contact Number:_

    DISPUTES (ATM /POS/WEB):


    Local ATM Dispute Global ATM Transaction (VISA Debit Card)
    Local POS Transaction (Access card) POS Transaction (VISA Card)
    Inter Branch Funds Transfer Inter Bank Funds Transfer
    Other

    TRANSACTION DETAILS
    Transaction
    Merchant Name / ATM Location & Bank Name Transaction Amount Disputed Amount
    Date

    REASONS FOR DISPUTE


    ATM Cash Not Dispensed (Attempted to withdraw cash from ATM Cash was not dispensed)
    ATM Cash Partially Dispensed (The amount on my receipt from the ATM differs from the cash received)
    Unauthorized Transaction (Did not participated or authorize the transaction)
    Multiple Duplicate Processing (I have been billed more than once by the same merchant)
    Amount Altered/Difference in Amount (Evidence of actual transaction is required)
    Paid by Other Means (Evidence of actual transaction is required)
    Goods /Services Not Received (Proof of Communication with merchant is required)
    Returned the Goods (Proof of Communication/returned goods is required)
    Cancelled Transaction/Service/Membership/Order (Proof of Communication/Cancellation is required)
    Other (Please provide full details of the dispute. Enclose necessary proofs and details)

    DECLARATION
     I hereby acknowledge that the above information is true to the best of my knowledge.
     I hereby acknowledge that should the dispute charge(s) prove to be valid or invalid, I am responsible for the payment of all dispute
    related charges and penalties as per the Bank's Schedule of Charges & VISA/Other Bank’s Charges on each disputed entry.
     Where Habib Metropolitan Bank Ltd. Requires, I shall provide affidavit in form prescribed by Habib Metropolitan Bank Ltd. along
    with any further information required by Habib Metropolitan Bank Ltd. for investigation and resolution of the disputed
    transaction(s) claimed by me.
     I hereby authorize Habibmetro bank to reverse claim amount in-case of any dispute receive in future from Visa or Merchant.

    ______________________________ ________________
    Signature of the Card Holder/Account Holder Date

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