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Cards Dispute Editable EN Form

This document is a cardholder dispute form used to dispute transactions shown on a credit card statement. It requests information such as the card number, statement date, details of disputed transactions including transaction number, date, merchant, and amount. The cardholder can then select a reason for disputing the transaction such as not recognizing the transaction, denying an authorization, a duplicate charge, or goods/services not received. The cardholder must declare that the information is true to their knowledge and that their card was in their possession at the time of the disputed transactions.

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375 views1 page

Cards Dispute Editable EN Form

This document is a cardholder dispute form used to dispute transactions shown on a credit card statement. It requests information such as the card number, statement date, details of disputed transactions including transaction number, date, merchant, and amount. The cardholder can then select a reason for disputing the transaction such as not recognizing the transaction, denying an authorization, a duplicate charge, or goods/services not received. The cardholder must declare that the information is true to their knowledge and that their card was in their possession at the time of the disputed transactions.

Uploaded by

rupamdhawan
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
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CARDHOLDER DISPUTE FORM

Card Number

D D M M Y Y
Details of disputed transaction(s) shown in my statement dated

S. No. Transaction Date (s) Name of Merchant Transaction Amount

1.

2.

3.

4.

I have examined the changes made to my card account and wish to dispute the aforementioned transaction/s for the
following reason:

✔ Transaction No. not recognized. Need more clarification on the following details:
Merchant Name Merchant Location Transaction date(s) Transaction amount

✔ Unauthorize or Not participated in the transaction No.

✔ Transaction No. Incomplete / Failed / Not authorized. Attached transaction slip (Yes / No)

✔ Transaction No. has been Duplicated, only one sale was authorized.

Incurred one transaction dated at the above mentioned merchant establishment and not incurred the
transaction(s) No. listed above. Attached a copy of accepted transaction (Yes/ No)

Transaction No. amount incurred was but billed for


Attached a copy of the transaction slip for genuine transaction (Yes/ No)

Service / Goods relates to Transaction No. not received. Expected date of receipt DD / MM / YYYY
Attached a copy of the letter to merchant attempting to resolve the dispute.

Credit voucher for the transaction No. was issued on but not processed to the card account.
Attached a copy of credit refund slip / cancellation letter from the merchant establishment.

Transaction No. Cancelled recurring Membership / Subscription. Date of Cancellation DD / MM / YYYY

Transaction No. , Hotel reservation cancelled on but billed for “no show” charge. The
cancellation number is

Transaction No. , Paid the amount by other means, evidence of payment by Cash / Cheque / Credit card /
Others is attached.

Other Dispute Reasons:

DECLARATION

I hereby affirm that the information furnished above is true to the best of my knowledge.
My card was in my possession and control at the time of the questioned transaction.
Name Contact Number

D D M M Y Y

Kindly e-mail back the completed dispute form from your registered e-mail ID to Dispute@Mashreq.com

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