CLIENT DISPUTE FORM

Metrobank Plaza, Sen. Gil J. Puyat Avenue, 1200 Makati City

Please accomplish this form with the required details below and provide all necessary supporting documents. Kindly note that all complaints on Metrobank Credit/Debit/Prepaid Card must be filed within 80 calendar days from the date of disputed
transaction(s). You may send the completely filled out form to [email protected] (for debit and prepaid card), [email protected] (for credit card). The Bank will only be able to proceed with the dispute process if
the requirements are complete. Therefore, it is important that the required steps, such as the blocking of the card, and the submission of the necessary supporting documents are promptly completed.

Client Name

Bank Account Number - - -

☐ Credit ☐ Debit ☐ Prepaid

Card Number with disputed transaction X X X - X X - -

Residence Number Office Number

Mobile Number E-mail Address

Please enumerate the transactions. Use additional sheets if necessary.

Disputed Amount
Transaction Date Merchant/Bank Name
(indicate currency)

I dispute the above transaction(s) for the following reason (Please tick one box only)
☐ DUPLICATE BILLING ☐ PAID BY OTHER MEANS
I was debited twice for the same transaction. Enclosed is the copy of the proof of I used another form of payment to pay for the above transaction(s). Enclosed is the copy
payment (i.e. transaction payment, acknowledgement receipt, transaction reference of the proof of payment (i.e. cash/check receipt, transaction receipt from different
number or screenshot of proof of transaction) debit/credit card)
☐ DEFECTIVE OR NOT AS DESCRIBED ☐ NO CASH DISPENSED
Goods/services received were either not as described, damaged/defective, or not I attempted to withdraw cash, however no cash was dispensed. Enclosed is a copy of the
suitable for its intended purpose. I have contacted the merchant to resolve the dispute. ATM transaction slip.
Date: ____________ Email/contact number: ________________________________ ☐ NON RECEIPT OF MERCHANDISE
Response: _____________________________________________________________ I did not receive the goods/services from merchant. Expected date of receipt:
Please specify the defect/discrepancy in the goods/services purchased versus what _________________. I contacted the merchant regarding this on ________________
were delivered/received: Please specify the description of the goods/services to be received:
_______________________________________________________________________ ___________________________________________________________________
☐ CREDIT NOT PROCESSED ☐ CANCELLED TRANSACTION/SERVICE
I did not receive the credit/refund as promised by the merchant. Enclosed is a copy of I have cancelled the transaction/recurring service with the merchant on
the credit memo issued by the merchant on ____________________. __________________. Please see acknowledged cancellation letter.
☐ INCORRECT AMOUNT ☐ UNAUTHORIZED TRANSACTION
The amount debited from my account was incorrect as transaction amount I neither participated nor authorized the transaction(s) indicated above. I did not sign
should be PHP_____________. Enclosed is the copy of the proof of payment with any slip nor received goods/services from the merchant.
the correct amount (i.e. transaction payment, acknowledgement receipt,
transaction reference number or screenshot of proof of transaction) ☐ I AGREE that the card used in the disputed transaction will be blocked.
☐ I DO NOT agree to have my card blocked. I will not hold the Bank responsible for any
☐ OTHERS (if none of the choices is applicable) transactions that may go through as a result of refusing to block the card.
Please provide a complete description of your dispute (i.e. buy load, bills payment, etc.)
------------------------------------------------------------------------------------------------
_____________________________________________________________________
☐ I AGREE to have my MBS, MBOnline, and/or MBOA User ID be disabled.
_____________________________________________________________________
☐ I DO NOT agree to have my MBS, MBOnline, and/or MBOA User ID be disabled. I will
_____________________________________________________________________
not hold the Bank responsible for any transactions that may go through as a result of
_____________________________________________________________________
refusing to disable the user ID/s.

In filing this dispute, I hereby affirm that:

☐ My Metrobank Credit/Debit/Prepaid Card has always been in my possession and had not been reported lost/stolen.
☐ My Metrobank Credit/Debit/Prepaid Card has been reported lost/stolen last _________________________ via:
☐ Contact Center (88700-700 hotline, [email protected], [email protected])
☐ Branch: _________________________
☐ ☐ I received an email, call, text message from the following number/email address: __________________________________
☐ I followed the instructions of the said caller/message. (e.g.: clicked the link/provided OTP/password) _______________________________________
By providing the information above and by affixing my signature on this Form, I authorize Metrobank to process and share my personal information mentioned in this Form with other banks and service providers that may help Metrobank in assessing
and validating my dispute. I declare that all information contained in this form is true and that the related documents provided are genuine and valid. I understand that the resolution of the disputed amount(s) is/are subject to the result of the
investigation and Metrobank does not guarantee that the disputed transaction(s) will be restituted. The provisions of the Credit/Debit/Prepaid card, Metrobank Online(MBO)/Mobile Banking(MBS)/Metrobank Online Application(MBOA) terms and
conditions shall also apply.

Signature Over Printed Name (Client) Date Filed

Privacy Notice: We collect and process your name, contact numbers, card number and bank account number when you file a complaint with Metrobank, for purposes of coordination and investigation.
You may revoke these authorizations at any time by notifying us at [email protected]. If you revoke these authorizations, however, it may affect our ability to investigate and to resolve your complaint. All personal information collected will be stored in a secured location; retained
in accordance with Metrobank’s retention policies; and only authorized employees will have access to them. If you think that your personal data was mishandled in terms of confidentiality or integrity, or if someone tampered with your personal data without your consent, please do not hesitate to
contact our Data Protection Officer through the following:
Data Privacy Department
10F Metrobank Plaza
Sen. Gil Puyat Avenue, Makati City 1200
Telephone Number: 63-2-8857-9664
E-mail Address: [email protected]

MB-I-M-192.1-t/Rev. Jul. '23