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Transaction Dispute Form

This document is a cardholder dispute form for HDFC Bank. It requests information from the cardholder such as their name, credit card number, and contact details. The cardholder is disputing transactions by providing the transaction date, merchant name, and amount. They must then select a reason for dispute such as unauthorized transactions, lost/stolen card, duplicate billing, cancellation of goods/services, defective merchandise returned, payment by alternate means, or other. The cardholder declares the information is true and agrees to pay any charges if the dispute is found to be invalid.

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365 views1 page

Transaction Dispute Form

This document is a cardholder dispute form for HDFC Bank. It requests information from the cardholder such as their name, credit card number, and contact details. The cardholder is disputing transactions by providing the transaction date, merchant name, and amount. They must then select a reason for dispute such as unauthorized transactions, lost/stolen card, duplicate billing, cancellation of goods/services, defective merchandise returned, payment by alternate means, or other. The cardholder declares the information is true and agrees to pay any charges if the dispute is found to be invalid.

Uploaded by

ashokjp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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CARDHOLDER DISPUTE FORM

To,
The Manager
HDFC Bank Cards Division
PO Box No. 8654
Thiruvanmiyur P.O.
Chennai 600041.
Please send the duly filled CDF from your registered email ID to [email protected]
NAME : ________________________________
CREDIT CARD NUMBER :

I am disputing the following transaction(s) for the reason given below and request you to settle the case(s) :
DETAILS OF DISPUTED ITEM(S) :
TRANSACTION DATE

MERCHANT NAME

TRANSACTION AMOUNT

Please select the most appropriate one :


I have neither authorized nor participated in the above transaction(s). I confirm that the card is still in my possession.
My card was lost/stolen on ______________ and the same was reported to you on ______________.
Duplicate/Multiple billing. I have done only one transaction at the Merchant Establishment but I was billed ____ times.

(Attach copy of authorized chargeslip)


I have cancelled the transaction(s)/returned the goods, but have not received credit/refund for the same (Attach Credit

Voucher/Refund note/Merchants letter or any form of merchants confirmation that the credit is due to the card account)
I had received defective merchandise/goods and had returned the goods to the merchant. (Attach Credit Voucher/Refund

note/Merchants letter or any form of merchants confirmation that the credit is due to the card account)
Paid by alternate means. I gave my card for payment, but later on paid by other means for the same transaction. I Paid by

Cash (attach cash receipt/bill)/ Cheque (attach Cheque /Bank statement)/ other card (attach chargeslip/other card statement)
Cancelled Membership/Subscription/Booking. (Attach the proof of merchant acknowledging the cancellation)
I ordered goods/services and the same were expected to be delivered by date (dd/mm/yy)___________, but I never received
the same. (Attach the proof of merchant acknowledging the cancellation)
The transaction amount incurred/authorized by me is for Rs.___________ but I was billed for Rs.__________. (Attach copy
of authorized chargeslip)
Cash was not dispensed at the ATM but I was billed for the entire amount of Rs._____________.
Cash was dispensed partially in the ATM for Rs.___________ but I was billed for the entire amount of Rs.__________.
Others (Please explain in detail. Please attach a separate letter if necessary)

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. The Bank may contact me whenever it requires any further
information.
Email/Phone / Fax: ______________________
______________________________________
Cardholder's Signature

Date

: _______________________________
________________________________
Add-on Cardholder's Signature (If any)

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