ATM - Complaint Form

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Format for lodging complaint by customers relating to ATM transactions.

To
The Branch Manager
The Catholic Syrian Bank Limited [Name of the Bank]
...................................................... [Name of the Branch] *
...................................................... [Name of the City]

1. Customer Information:
Name of the Customer:
Account No.:
Debit Card/ATM Card No.:

2. ATM Information:
ATM ID/Location,
if ID is not available:
Name of the ATM Bank:

3. Nature of the Complaints:


a)Complaint relating to Cash withdrawal:
Amount requested for withdrawal : Rs
Amount actually disbursed at ATM : Rs
Amount debited to the account : Rs
Date of transaction: ___/___/___(mm/dd/yy)
Time of transaction:
b) Card Capture by ATM:
c) Other complaints:

Date: __/__/__ Signature of the Card Holder

Contact Tel/Mobile No.

*(Name of the bank branch where cardholder account is maintained which is linked to ATM card)

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