DISPUTE FORM - SBI Card

[Pages:1]Reach us at Chargeback Unit, 10th Floor, DLF Infinity Tower C, Gurgaon-122002 / fax ? 0124 ?3992476 e-mail id : chargeback@

DISPUTE FORM

Name _______________________________________ Mobile / Landline Number __________________ SBI Card Number ____________________________________ Email id ____________________________

Transaction Date

Details of the Disputed Item (s)

Merchant Name

Transaction Amount Disputed Amount

DECLARATION: I am disputing the transaction (s) listed above for the reason as follows:

__D_u_p_l_ic_a__te__C_h_a_r_g_e__(A_t_t_a_c_h_c_o_p__y_o_f_a_c_c_e_p_t_e_d__tr_a_n_s_a__ct_i_o_n_c_h_a__rg__e_sl_ip__/T_i_c_k_e_t_b_o_o_k_i_n_g__H_is_t_o_ry for online transactions)

I have enI chlaovseedbetheenfcohllaorwgiendg tdwoiccuemfoerntthseasloanmgewtritahntshaicstfioonrmo:n: ___________________ 1. _____I_i_n_c_u_r_re_d__o_n_e__tr_a_n_s_a_c_t_io_n_-_d_a_t_e_d________________a_t_t_he above merchant establishment

2. ____________________________________________ 3.A_T_M__C_a__sh__N_o__t _R_e_c_e_iv_e_d_________________________ A DECLACRaAsThIONNot dispensed_______ I herePbayratiafflirammtohuanttthdeispinefnosrmedabtioynATfuMrn_is_h_e_d__a_bove is true to the best of my knowledge.

My card was in my possession and control at the time of the questioned transactions.

CaPradihdoflodreGr'sooSidgsnbaytuOrether Means- (Attach copy of cash memo/ bank statement/other bank card statement)

Cash

Cheque / DD/ Credit card #_________________ Date ____________

Ordered Goods or Services not received (Attach copy of order receipt/booking details) Tickets/merchandise not received. Expected Delivery Date: __________________

Credit Not Processed (Attach copy of Credit Voucher/Refund note/Merchant's letter or any form of merchant confirmation that the credit is due)

Date of Credit Voucher Issuance: __________________

Billed for No-Show Charge after Cancellation (Attach copy of proof of cancellation) Cancellation Date: __________________ Cancellation Number: _____________

Incorrect Transaction Amount (Attach copy of chargeslip/document for the accepted amount) The transaction amount incurred was _______, but I have been billed for ____________

Fraudulent Transaction(s) (card blocking mandatory) Neither me nor my family members incurred or authorized the above transactions.

Tyh OtherMs (yacnayraddwdaitisolnoasltc/osmtomleennotns) date ________ and was reported to SBI Credit Cards on date ________

Other Comments _ _____________________________________________________________________ ___________________________________________________________________________________________

I declare that above given information is true and correct to my knowledge. I understand that I can be held liable for all charges incurred if dispute raised by me is found invalid. I agree to pay the charges levied by the bank for the same including the cost incurred for investigation of my claim. By ticking the option for fraudulent transaction(s), I permit SBI Cards to de-activate the card on which the fraudulent transaction(s) took place.

Cardholder's Signature __________________________________________

* Please note that a Retrieval Fee of Rs. 225 (plus service tax as applicable) shall be charged per

1

transaction to your Card Account if case does not close in your favour.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download