Card transaction dispute form
To dispute a transaction on your card, simply complete, sign and return this form by sending it to this email address:
Please include a copy of any statement, card transaction slip, invoice or any form of communication with the merchant that
will help resolve the disputed transaction. If you need more information, contact us on 0800 07 96 97.
Important:
Dispute times can expire so please complete and return this form as soon as possible so we can work with other banks
to resolve it.
If the transaction dispute is unsuccessful, you’ll have to pay an administration fee. You can get a copy of our fees by
emailing a request to or you can view them using our banking app.
The terms and conditions you agreed to when you opened your account apply to the disputed transaction. The contents
of this form do not replace them.
Depending on the dispute outcome, you agree that we may credit or debit your account with the transaction amount.
If the accountholder is younger than 18 years, the accountholder’s parent or guardian must complete and sign the form.
Your details
Card number ******
Cardholder name
Contact number
Email address
Physical address
Details about the transaction you want to dispute
Transaction date Merchant name/ATM details Amount
1.
2.
3.
4.
1 Discovery Place, Sandhurst, Sandton, PO Box 786722, Sandton 2196 | 0800 07 96 97
Discovery Bank Limited. Registration number 2015/408745/06. An authorised financial services and registered credit provider.
FSP number 48657. NCR registration number NCRCP9997. Limits, terms and conditions apply.
Details about the transaction you want to dispute
Transaction date Merchant name/ATM details Amount
5.
This amount was debited to my account more than once.
Please attach and highlight the statement details and provide proof that you attempted to resolve the dispute with the merchant.
I returned the goods to the merchant and received a credit voucher, which does not appear on my account.
Please provide credit voucher or acknowledgment of a refund from the merchant. Also, please provide proof that you
returned the goods and attempted to resolve the dispute with the merchant.
I paid by other means.
Please send us proof of payment and that you attempted to resolve the dispute with the merchant.
The transaction amount debited to my account differs from what was agreed on with the merchant.
Please provide proof of the correct amount agreed on with the merchant. For example, a slip or invoice, provide
proof that you attempted to resolve the dispute with the merchant.
from to
I contacted the merchant to cancel purchased goods or services but my account was debited.
Please provide reason and proof of cancellation, a description of the goods or services and proof that you attempted to
resolve the dispute with the merchant
Goods ordered online or by mail or telephone order were not received.
Please describe the goods or services ordered and the date on which the goods and services should have been received or
delivered and provide proof of attempting to resolve the dispute with the merchant.
Goods or services were not received within the agreed period.
Please describe the goods or services ordered and the date on which the goods and services should have been received or
delivered and provide proof that you attempted to resolve the dispute with the merchant.
1 Discovery Place, Sandhurst, Sandton, PO Box 786722, Sandton 2196 | 0800 07 96 97
Discovery Bank Limited. Registration number 2015/408745/06. An authorised financial services and registered credit provider.
FSP number 48657. NCR registration number NCRCP9997. Limits, terms and conditions apply.
Goods or services are not as described or were damaged or did not work.
Please describe the goods or services ordered or details of the damage. Attach proof of what you expected to receive against
what the merchant provided to you and provide proof that you attempted to resolve the dispute with the merchant.
I made a hotel reservation, but cancelled and was still charged.
Please attach the reservation and proof of cancellation and provide proof of attempting to resolve the dispute with the merchant.
ATM transaction: Cash not dispensed at all.
Please attach the ATM slip if available.
ATM transaction: Some cash dispensed.
Please attach the ATM slip if available.
Amount requested Amount received
Other reason not detailed above.
Please provide more details.
Additional information
1 Discovery Place, Sandhurst, Sandton, PO Box 786722, Sandton 2196 | 0800 07 96 97
Discovery Bank Limited. Registration number 2015/408745/06. An authorised financial services and registered credit provider.
FSP number 48657. NCR registration number NCRCP9997. Limits, terms and conditions apply.
Declaration
I confirm that all the information I have provided is correct, and that Discovery Bank can rely on this information.
I agree that Discovery Bank will not be legally responsible in any way for relying on or using this information.
I understand that by requesting Discovery Bank to reverse the authorisation, it will not prevent the merchant from
processing the transaction and debiting my account.
I understand that when it comes to disputes for international transactions, the final rand value amount based on the
outcome of the dispute may differ from the initial disputed rand value amount because of fluctuations in the exchange rate.
The conversion rate will be the exchange rate on the date of the successful resolution of the dispute.
I also understand that providing false information or withholding necessary information is a misrepresentation
(negligent or fraudulent), which may lead to criminal or civil prosecution, or both.
Signature of cardholder, accountholder or
Date
parent (guardian) if accountholder is under 18 years
1 Discovery Place, Sandhurst, Sandton, PO Box 786722, Sandton 2196 | 0800 07 96 97
Discovery Bank Limited. Registration number 2015/408745/06. An authorised financial services and registered credit provider.
FSP number 48657. NCR registration number NCRCP9997. Limits, terms and conditions apply.
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