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    PNB Dispute Form PDF

    Uploaded by

    Kitol Pepito
    This document is a dispute form for a credit card transaction. It contains the cardholder's information, details of the disputed transaction, and sections for the cardholder to select the reason for dispute and provide supporting documentation. Common reasons for dispute include incorrect amount charged, unauthorized transaction, non-receipt of goods/services, and returns not credited. The form notes that any provisional credit is pending investigation and may be reversed if the transaction is found to be valid. It also lists required documents and retrieval fees that may apply.

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

    PNB Dispute Form PDF

    Uploaded by

    Kitol Pepito
    4K views2 pages
    This document is a dispute form for a credit card transaction. It contains the cardholder's information, details of the disputed transaction, and sections for the cardholder to select the reason for dispute and provide supporting documentation. Common reasons for dispute include incorrect amount charged, unauthorized transaction, non-receipt of goods/services, and returns not credited. The form notes that any provisional credit is pending investigation and may be reversed if the transaction is found to be valid. It also lists required documents and retrieval fees that may apply.

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    PNB Dispute Form.pdf

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    This document is a dispute form for a credit card transaction. It contains the cardholder's information, details of the disputed transaction, and sections for the cardholder to select the reason for dispute and provide supporting documentation. Common reasons for dispute include incorrect amount charged, unauthorized transaction, non-receipt of goods/services, and returns not credited. The form notes that any provisional credit is pending investigation and may be reversed if the transaction is found to be valid. It also lists required documents and retrieval fees that may apply.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4K views2 pages

    PNB Dispute Form PDF

    Uploaded by

    Kitol Pepito
    This document is a dispute form for a credit card transaction. It contains the cardholder's information, details of the disputed transaction, and sections for the cardholder to select the reason for dispute and provide supporting documentation. Common reasons for dispute include incorrect amount charged, unauthorized transaction, non-receipt of goods/services, and returns not credited. The form notes that any provisional credit is pending investigation and may be reversed if the transaction is found to be valid. It also lists required documents and retrieval fees that may apply.

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

    Email to
    Contact us at
    CARDHOLDER'S NAME
    CARDNUMBER
    Merchant Name

    02-892-7427 / 812-6247
    allylive@alliedbank.com.ph
    02-818-9-818 (Metro Manila) / 1800-10-818-9-818 (Domestic Toll-Free Number)
    Romeca Kristine Kate Pepito
    ______________________________________
    ______________________________________
    Tran Amount

    Tran Date

    Post Date

    Reference Number

    I received my billing statement on ________ (mmddyy) for the month of ________ (mmyy) and do not agree with the transaction/s stated above due to
    the following reason/s: (copies of documentation/s attached)
    Please check appropriate reason of dispute:
    I am not sure of the transaction and am requesting for a copy of the sales draft.
    I have been charged twice / thrice
    Support Documents Needed:
    Cardholders copy of Saleslip of Retail Transaction
    Cardholders copy of ATM Receipt for Cash Advance and ATM Transaction

    I have been charged an incorrect amount. The amount agreed is amounting to ________ and billed as________.
    Support Documents Needed:
    Any written document or Proof that stipulates valid amount
    Ex. Contract/Sales Draft/ Itemized Billing
    Copy of Statement of Account

    My card/s were reported Lost/Stolen on ________ (mmddyy) at about ________ pm/am. Call was received by ________
    (authorizer name).
    Support Documents Needed:
    Affidavit of Loss

    My Allied MC card is always in my possession. I have not authorized anyone to use my card. The transaction performed at the
    merchant indicated above was not made with my credit card and I have not benefited directly or indirectly from the transaction. I
    shall be sending over said physical card for proper investigation on _______ (mmddyy).
    Support Documents Needed:
    Photocopy of Front and Back part of credit card
    Statement of Account
    Physical Card for processing of Card Replacement

    Merchant promised to reverse the transaction but amount has not been credited to my account.
    Support Documents Needed:
    Credit Memo / Credit Advice / Voided Saleslip issued by merchant
    Merchants letter confirming reversal of the amount
    Cardholders letter indicating date of cancellation

    I ordered goods/services relating to the above transaction/s which I have not received.
    Support Documents Needed:
    Contract/Merchants Letter/ Any written document showing
    delivery date of ordered items / Cardholders Progressive Letter
    Cardholders Copy of Sales Draft
    Statement of Account

    I returned the ordered goods on _______MMDDYY due to_______________. But amount has not been credited to my account.
    Support Documents Needed:
    Return Receipt
    Cardholders progressive letter / Sales Draft with merchants
    acknowledgement

    Others: ______________________________________________________________________________
    In connection with my above claim, I fully understand that any amount credited to my account is provisional pending final outcome of
    investigations. Further, should the transaction prove to be true and genuine, I understand that the disputed amount shall be reflected on my
    next billing statement with corersponding finance charges and retrieval request fees where applicable.
    Signature:
    _________________________
    Contact Number: _________________________
    Retrieval Fees
    Local
    Sales Slip:
    P400.00
    Statements:
    P50.00

    Date: ______________
    International
    US$15.00
    P50.00

    Note: Fees subject to change without prior notice.


    A scanned or clear copy of valid ID with verifiable signature is required for all dispute cases.
    Required documents must be submitted within five (5) banking days from date of complaint, otherwise, dispute will be
    considered closed.

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