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    Dispute Claim Form: Personal Information

    Uploaded by

    Optimi
    This dispute claim form allows a cardholder to dispute a transaction on their credit card statement. The cardholder provides their personal information and details of the disputed transaction, including the merchant name, transaction date, and amount. They then select the reason for disputing the transaction from options like the ATM not dispensing cash, returning goods to a merchant, or cancelling a travel booking. By signing the form, the cardholder agrees to pay any fees for the bank to request documents from the merchant and confirms that all information provided is true. The form should be submitted with any supporting documents to the cardholder's bank to process the dispute.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dispute Claim Form: Personal Information

    Uploaded by

    Optimi
    244 views1 page
    This dispute claim form allows a cardholder to dispute a transaction on their credit card statement. The cardholder provides their personal information and details of the disputed transaction, including the merchant name, transaction date, and amount. They then select the reason for disputing the transaction from options like the ATM not dispensing cash, returning goods to a merchant, or cancelling a travel booking. By signing the form, the cardholder agrees to pay any fees for the bank to request documents from the merchant and confirms that all information provided is true. The form should be submitted with any supporting documents to the cardholder's bank to process the dispute.

    Original Description:

    Dispute Claim Form v1-2016

    Original Title

    Dispute Claim Form v1-2016

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    This dispute claim form allows a cardholder to dispute a transaction on their credit card statement. The cardholder provides their personal information and details of the disputed transaction, including the merchant name, transaction date, and amount. They then select the reason for disputing the transaction from options like the ATM not dispensing cash, returning goods to a merchant, or cancelling a travel booking. By signing the form, the cardholder agrees to pay any fees for the bank to request documents from the merchant and confirms that all information provided is true. The form should be submitted with any supporting documents to the cardholder's bank to process the dispute.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    244 views1 page

    Dispute Claim Form: Personal Information

    Uploaded by

    Optimi
    This dispute claim form allows a cardholder to dispute a transaction on their credit card statement. The cardholder provides their personal information and details of the disputed transaction, including the merchant name, transaction date, and amount. They then select the reason for disputing the transaction from options like the ATM not dispensing cash, returning goods to a merchant, or cancelling a travel booking. By signing the form, the cardholder agrees to pay any fees for the bank to request documents from the merchant and confirms that all information provided is true. The form should be submitted with any supporting documents to the cardholder's bank to process the dispute.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Dispute Claim Form

    Personal Information
    CardHolder Name Surname
    Contact Number Email
    Card Number
    Account Number

    Transaction Information
    Merchant/ATM Name: Transaction Date:
    Amount Reference No

    I have checked my statement and dispute the abovementioned transaction for the following reason (tick applicable box):

    Merchant/ ATM Transaction


    I attempted to withdraw funds at the ATM but the ATM did not give me any cash.
    I attempted to withdraw funds at the ATM but the ATM only paid out an amount of
    I returned the goods to the merchant and received a credit voucher, which does not appear on my account. (Attach credit voucher)
    I only did one transaction at this merchant (Attach a copy of your transaction slip). I did not authorize the additional transaction.
    Transaction was paid for in another way. (Attach proof of payment)
    Request for copy of the transaction voucher from the merchant. (Kindly note that we will charge a fee for requesting a copy of the
    transaction voucher from the merchant.

    Travel and Entertainment


    I made a hotel / vehicle hire booking, but cancelled the booking. (Attach proof of the cancellation letter)
    I made a hotel booking, stayed at the hotel and was charged a No Show. I attempted to resolve the dispute with the merchant more
    than 30 days ago. (Attach copy of communication to merchant)

    I made a hotel / vehicle booking but the booking / holding fee is still debited though I have been charged for the use.

    Mail/Telephone/Online Purchase
    I never received the merchandise that I have been debited for. I attempt to resolve the dispute with the merchant more than 30 days
    ago. (Attach copy of communication to merchant/service provider

    I returned the merchandise. (Attach a copy of the return slip)


    Others (please summarise)

    Your Declarations by signing this form I confirm the following


    1. I will be legally responsible to pay the required fees should Steward Bank request a copy of the transaction voucher from the merchant
    on my behalf. (Actual price to be availed on request)
    2. All information and documents that I have given Steward Bank are true, authentic and correct.
    Date:
    Full Name Client Signature

    For Office Use Only Form submitted by


    Name & Signature Branch

    To prevent any delays in processing the dispute please ensure that all supporting documentation is attached where required.
    Email this form to cardcentre@stewardbank.co.zw or drop at your nearest Steward Bank Branch.

    www.stewardbank.co.zw

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