Transaction Dispute Form Date: _____________

Name VIMPY JAIN

Card Number (mandatory) 79

Details of Disputed Item(s)

TRANSACTION MERCHANT/SHOP/ESTABLISHMENT TRANSACTION DISPUTED

DATE NAME/ATM LOCATION AMOUNT (Rs.) AMOUNT (Rs.)

26/10/2024 IKEDA PRIVATE LIMITED IN 39720/- 39720/-

I am disputing transaction(s) mentioned above due to the following reasons (please tick the appropriate reason/s). Request you to
resolve the dispute.

1. I have neither authorized nor participated in the above transaction(s). The card was in my possession at all times. I authorize SBI
Card to block my credit card as per the Visa / Mastercard / RuPay / Amex norms.

2. I’d ordered goods/services and the same were expected by date _26__/_10__/2024__, but I never received the same. I contacted
the merchant on date _27__/10___/2024 and their response was _merchant said that they not receive the paper (Please specify
what good(s) or service(s) were expected. Also attach correspondence with merchant for order status).

3. The transaction was unsuccessful, or the merchant confirmed non-receipt of payment (Provide a clear description of the goods or
services ordered / copy of all correspondence with the merchant)

4. Duplicate/multiple billing: I have done only one transaction, but I was billed ______ (Twice/Thrice etc.). (Attach accepted
transaction receipt, showing the actual amount).

5. Paid by alternate means: First I gave my card for payment but later changed my mind and paid by Cash (attach cash
receipt/bill)/Cheque (attach cheque receipt/bank statement)/Other card (attach charge-slip/other card statement).
6. The goods supplied/serviced by the merchant are not as described: The item(s) purchased or service(s) paid for do not conform to
what was agreed to have been supplied by the merchant or was/were defective. (Please specify what good(s) or service(s) were
expected & what were actually delivered. Enclose any documentation that supports your claim. Please return the goods to the
merchant & provide proof of returned goods, copy of correspondence with merchant, terms & conditions of contract/delivery
and nature of defect etc).

7. The transaction amount was Rs. ________ (provide amount & currency), but I was billed for Rs. __________ (provide amount &
currency) (Attach a copy of charge-slip/sales slip/statement of card account).

8. Transaction got cancelled, but I have not received credit/refund for the same (Attach credit slip/refund note/merchant’s letter or
any form of confirmation from the merchant that the transaction was cancelled, and credit was due to you).

9. Cancelled membership/subscription/booking, but I have been billed for Rs.______ (Attach the cancellation letter which you sent to
the merchant).

10. Cash not dispensed by the ATM, but I was billed for the amount of Rs._______ /Cash dispensed partially by the ATM for
Rs.________ but I was billed for the entire amount of Rs. _______ (Attach copy of ATM slip).

11. My card was lost/stolen at _____AM / PM on ___/___/___ and I’ve reported the same to SBI Card at _____AM / PM on
___/___/___ by way of _________________ (Attach copy of FIR filed with police, if any).

12. Others (Please explain in detail. Please attach a separate letter, if necessary).

Declaration:

I declare that the information given above is true and correct to the best of my knowledge. I understand that I can be held liable for all
charges incurred before the time of reporting of loss/theft and also if the dispute raised by me is found invalid. I agree to pay the
charges levied by SBI Card for the same.

Any Additional Comments:

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Primary Cardholder's Signature __________________________

IMPORTANT NOTES:-

(i) On receipt of the dispute claim along with relevant supporting documents (refer page 2 for the list of documents / details
required) within the timeframe as mentioned below, we will take up the matter with the member bank and request them to provide the
details on the basis of which the disputed charge was processed to your card account.

Transaction and Network Type Time (from the transaction date)

Domestic & International Transactions 90 Days

(Visa / Mastercard /American Express)
 International Transactions 90 Days
(RuPay)

Domestic and UPI Transactions 30 Days

(RuPay)

(ii) On receipt of clarifications from member bank regarding the disputed charge, we shall revert to you with the clarifications on
the dispute, which takes normally around 30 to 45 days in accordance with the Visa / Mastercard / RuPay / Amex rules.

(iii) In case we do not hear from you by the stipulated revert date, the disputed transaction shall be construed to be in order, and
we shall be constrained to close the matter at our end.

(iv) Request to the Cardholder: Please attach copies of your correspondence with the merchant and charge-slips wherever
applicable and any supplementary documents pertaining to the transaction(s) as appropriate.

List of documents and/or details required for transaction dispute:

Reason for Transaction Dispute Details / supporting documents required Example (for your reference only)

Services / Goods not received -Detailed description of goods / services ordered Ordered a new mobile phone from an
/ purchased online merchant and not received
within the promised timelines.

Product was expected by 15th March

- Expected date of delivery 2020

Additionally, you can share proof of

merchant interaction
Services / Goods not as described Ordered a red T-shirt from an online
- Detailed description of goods /
merchant and have receive a green T-
merchandise ordered / purchased
shirt

- Have you returned the

goods / merchandise to merchant? Please
confirm Yes or No

- Details of the return of

goods / merchandise (Date and mode of
return)

Merchant has not received the amount / -Detailed description of goods / services ordered Making an online payment towards my
failed transaction / purchased phone bill. During the process, the
transaction failed but I have still been
- Expected date of delivery charged for the same.

Was making payment on 1st March

2020, services expected immediately.

Credit / Refund not processed - Proof of credit note / refund note or Copy of SMS / E-mail received from
void transaction slip (attach document) merchant that he is issuing a refund
on your SBI Credit Card ending with
- For failed transaction, share proof of XXXX
alternate payment
Copy of SMS / E-mail that product or
service is cancelled / goods returned
and refund will be received in 7-10
business day

Paid by Other Means

- Proof that payment was made by any Copy of Bank Statement for other
other mode. (attach document) credit card / Other credit card
payment slip
- For failed transaction, share proof of
alternate payment Receipt / Memo for payment made
in Cash
Difference in Bill Amount - Proof that original transaction was Original product
supposed to happen for a different amount Price / original invoice along with
and the billed transaction amount is final billed receipt / invoice
different (attach document)