Te Tre Manager Operators 1G Bar Liviene HED Bort Tower, - Wing amomnn Excite, New Cranctvat Sto ‘Onandivest Earn Booed Opp MAhite Cteony, Chron a ‘ ‘Andes Rent), Muri: 40007: e caronumoen 4 0 3 F 62132 1 4 DETAILS OF DISPUTED ITEM Charge Getaits shown in my statement dat TRANSACTION MERCHANT TRANS.AC i NAME AMOUNT 23 |PAYZAPP WALLET nucral 2 2. PAY CREDITCARD MmAL gos & E CHARGE PAYCIECT £ ket Goithan! |“ + 22. TE ere AURA eh 2 AS 26 = $e. FAG IK fey FREE cM PRYPIENT FEY OU Biéstrars! S99 wh Senay Tam he transactionis) lsted above forthe reason as follows and request you to seme the cases "have neither incurred nor authorised the above transactions {have been charged twice forthe same transaction {have incurred one transaction dated at the above merchant establishment. However, {have incurred or authorised the transactions listed above. ‘Antached is my copy of chargeslip for the genuine transaction. The transaction amount incurred was but! have been billed for _ ‘Anached is my copy of chargeslip showing the actual amount. ‘2. {have never received the ordered merchandise whose delivery date was __ “attached is 2 copy of my letter to the merchant attempting to resolve the dispute 1D. My hotel reservation was cancelled on " However | have been bilad a No-Show Charge. The number is 1B already paid the transaction amount by other means and the evidence is enclosed Paid by Cash/ Cheque/ DD/ Credit Card #. dated i Enclosed is @ copy of my Cash Memo/ Bank Statement/ Payment Counterfoil/ Card Statement, Q The credit voucher was issued on but not processed to my account. ‘Attached ig a copy of my Credit/ Refund Slip/ Cancellation letter from merchant establishment. ‘ATM Transaction attempted by me did not dispense cash for Rs. 2. ATM Transaction attempted by me partially dispensed cash for Rs. ‘Attached is my copy of ATM sli D Others ( any additional comments) DECLARATION ‘Thereby affirm thet 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 transactions. ‘Name: Segigan Kur Tens Ider's Signature 1List of Documents Ira tiiate lrveatigation fr the daputed transaction, the Cardholder needs to submit» copy ofthe Below mentioned documents. a = sree - wi ‘Type ot Care| Documents Required ae {bul Titod Customer Diepute Form (CDA). CDF to be signed by the Card which dispute is being raised, nich disp ing raised rntioned below (Please carry the original Copy of any one Photo 1D proof m Debit Card’ | document for verification): Passport PAN Card Voter 10 Card Driving licence Government 10 Card Photo Ration Card Senior Citizen 1D Card icooooGe To establish proof of presence, please provide the following documents. In case of Joint Accountitransaction is done using Add-on Credit Card, the proof of presence will be required for all holders | Twreot | ‘Type of Card Documents Required feces 7, the cardholder was in the same location where disputed transaction took | place, please provide any of the below mentioned proof which substantiates | the claim. | OH letter confirmation, ifthe cardholder was present in office on the date of | disputed transactions. HR letter should be on Company letter head duly signed | and stamped | Domestic | O Statement of usage of any other bank card on date of disputed transactions International | Debit Card) | confirming cardholder's availability in that particular place and city Credit Card | Q Hotel stay proof on date of disputed transactions confirming presence in that particular place and city . ttemised postpaid mobile bill of the cardholder for the period when disputed transaction has taken place 2. ifeardholder was not present in the country where the disputed transactions | International took place, | Please provide a copy of all the pages of the passport. : Cardy 4 . : Domestic & © Police Complaint copy, if lodged eee ary ku -Teng Cardholder's Signature