Grievance Form Pbe
Grievance Form Pbe
Grievance Form Pbe
Nama J A M I S B I N K U N A N G
Name
No. K.P./Pasport 7 7 0 6 0 5 1 2 5 0 5 1 Jantina
x Lelaki Perempuan
IC/Passport No. Gender Male Female
Alamat
Address l o t 7 8 , l o r o n g b a y u i d a m a n 4 . T a m a n B a y u
i d a m a n , J a l a n s h a b a n d a r T u a r a n
Poskod 8 9 2 0 8 Alamat E-Mel james .kunang@gmail.com
Postcode E-Mail Address
No. Telefon (Bimbit) 016 No. Telefon (Rumah/Pejabat)
Telephone No. (Mobile) 8 1 8 9 9 1 3 Telephone No. (House/Office)
MAKLUMAT AKAUN/KAD / ACCOUNT/CARD INFORMATION Sila tandakan mana yang berkenaan/Please tick whichever is applicable
Nombor Akaun/Kad
Account/Card Number
x Simpanan 6 8 4 4 8 0 6 8 0 3
Savings
Semasa
Current
Simpanan Tetap
Fixed Deposit
Pinjaman
Loans
(No. Nota Pinjaman / Loan Note No.)
Kad Kredit/Debit
Credit/Debit Card
SALURAN SERAHAN / DELIVERY CHANNEL Sila tandakan mana yang berkenaan/Please tick whichever is applicable
ATM Mesin Tunai Kitar Semula (CRM) Perkhidmatan PBe Pindahan Dana Elektronik di Tempat Jual Terminal Wang Masuk (CDT)
ATM Cash Recycling Machine (CRM) x PBe Service Electronic FundsTransfer at Point of Sale Cash Deposit Terminal (CDT)
EMV POS (Sila lengkapkan Surat Pertikaian untuk Kad Visa/MasterCard/ATM) Lain-lain
(Plese complete the Letter of Dispute for Visa/MasterCard/ATM Card) Others
BENTUK ADUAN (Sila masukkan ke dalam CGS dengan segera) Sila tandakan mana yang berkenaan/Please tick whichever is applicable
NATURE OF COMPLAINT (Please input into CGS immediately)
Dana tidak diterima Dana tidak dibayar kepada benefisiari Akaun didebitkan tetapi tunai tidak dikeluarkan Percanggahan semasa penerimaan dana
Non-receipt of fund Non-payment of fund to beneficiary Account debited but cash not dispensed Discrepancies on receipt of fund
Wang tunai tersekat di CDT/CRM / Dana tidak dikredit Jumlah yang sepatutnya ialah dan bukannya
Cash jammed at CDT/CRM / Non credit of fund Amount should be instead of
x Lain-lain (sila nyatakan) telah memindahkan wang kepada akaun yang salah
Others (please specify)
Tempat Urus Niaga Tarikh Urus Niaga 21/10/2021 Masa Urus Niaga 06:26:24 am
Transaction Location
pbe online Transaction Date Transaction Time
Nombor Rujukan 424649 Nombor Terminal
Reference Number Terminal Number
Butir-butir Percanggahan:
Discrepancy Description Jamis Bin Kunang
Tandatangan Pelanggan/Customer’s Signature
PERAKUAN PENERIMAAN KEPADA PELANGGAN / ACKNOWLEDGEMENT TO CUSTOMER
(Tidak berkenaan bagi EMV POS/Pertikaian ATM Luar Negara / Not applicable for EMV POS/Overseas ATM Dispute)
Kami mengaku menerima laporan di atas dan akan memaklumkan kepada anda hasil siasatan kami dalam masa 14 hari.
We acknowledge receipt of the above report and will inform you of the outcome of our investigation within 14 days.