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    Card Disputes Live Chat Form v2.2020

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    c-sabrina1

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    © All Rights Reserved
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    Card Disputes Live Chat Form v2.2020

    Uploaded by

    c-sabrina1
    2 views4 pages

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2 views4 pages

    Card Disputes Live Chat Form v2.2020

    Uploaded by

    c-sabrina1

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    GB HBUK RBWM PDF ADLS

    DISP1UTEJCGPMI 000003 40052651467972 CLBS_CD


    CD_S1

    Card Dispute Declaration Form

    Dear Customer
    Thank you for contacting us about the disputed transaction(s) on your account. To help us investigate this for you,
    please complete the enclosed Declaration Form. We have provided guidance on the steps below:

    To start our investigation, Please Provide:

    • The appropriate reason for disputing the transaction(s) on your account


    • The relevant details for the transaction(s) that you are disputing
    • Any relevant supporting document(s) as outlined in the “Documentation” section below. Please do not submit
    the form without the relevant documentation
    • Confirmation that the relevant information shared by you is complete and correct
    • Your signature within the “Declaration” section
    • To submit the form electronically click “Submit”

    Next Steps
    • Once we receive your completed declaration form, we will then investigate the matter for you.
    • If a claim can be made against the retailer, we’ll apply a credit to your account for the disputed transaction(s). The
    retailer can then contest the claim and provide us with the information. We’ll let you know if the claim is
    unsuccessful and if the credit will need to be reversed.

    If your transaction meets the criteria, we will also review for a Section 75 claim. We may need to contact you again for
    further information.
    Dispute Declaration Form
    Important Note:
    • Please complete a separate form for each dispute reason

    1. Card Details
    S CHALLAL

    Debit

    ****** ********

    4659427279292289

    2. Nature of Dispute
    a. Dispute Reason (please select one)

    I have been charged for the same transaction more than once on the same card for the same merchandise/service
    I have paid for the transaction(s) by other means

    Incorrect Amount Charged: I have been billed in .

    Missing Refund: I have received a refund that I have been expecting/promised.


    I have an issue with merchandise/service(s) that I ordered/purchased. The order was related to
    I am being charged on a recurring basis for service(s)/subscription(s) that I have cancelled or not agreed to
    I have an issue with ATM Cash Withdrawal transaction(s)
    I have another reason to dispute the transaction(s), i.e. none of the above

    b. Dispute Details

    I have paid for the merchandise/service by :

    The currency I have been billed in is , but I should have been billed in

    I confirm that I have tried to resolve the issue with the merchant through

    The merchandise/service was not delivered at all.

    The merchandise/service was delivered partially.

    The Expected Date of Delivery was

    , but not acceptable as these were

    No

    Yes No

    Have you attempted to claim a refund from the bonding authority? Yes No

    Have you suffered additional losses as a result of the issue with the goods/services being
    disputed?(These could include additional hotel costs, transfers, or other paid for services/ Yes No
    goods that you were unable to use as a direct result of the failure that caused your initial
    dispute)
    Please provide a description of the additional losses that you have suffered below:

    My first communication with the merchant was on was and my last communication with the merchant
    on

    The was on

    The merchant is unable to fulfil the services. The remaining no. of sessions/duration are

    The merchandise was returned or made available for return on

    The merchant the return of merchandise

    The merchandise was not returned because (reason for not returning the merchandise):

    Description of Merchandise/Service (including brand, make, model, quantity, destination, mode of travel, etc., as
    applicable):

    Describe why the Merchandise/Service was not acceptable:

    Cash was dispensed

    I was charged more than once for the same withdrawal

    Description of reason for the dispute:

    I haven’t made 2 payments of £86.98 at tkmaxx Watford on Friday the 29th of October.

    Any other relevant information related to the dispute:

    I was in Peckham at that time. Never been to Watford since I live in the UK
    3. Transaction Details

    Transaction Date Merchant’s Name Transaction Amount (£) Disputed amount (£)
    ✔ 29/10/2021 Tkmaxx 86.98 86.98
    ✔ 29/10/2021 Tkmaxx 86.98 86.98

    4. Documentation

    Copy of

    Copy of
    Proof of Credit/Void Receipt or confirmation of refund issued by merchant
    Proof of return and/or cancellation of merchandise/service
    Merchant’s return or cancellation or refund policy agreed at the point of sale
    Copies of correspondence with the merchant
    Supporting document from a neutral qualified merchant in similar business certifying that the
    merchandise or service was counterfeit or defective
    Proof of claim from Bonding Authority (e.g. ATOL, ABTA), showing that the bond is insufficient to cover
    the claim
    Evidence of services that cannot be utilised
    Any other evidence that may support your claim (e.g. evidence of administration)

    5. Declaration

    By submitting this form I confirm the following:

    ✔ I understand that it may not be possible to claim for a transaction that is older than 120 days.
    ✔ I have provided all information and/or copies of all documentation received till date relating to the disputed
    transaction(s).
    I have made every possible effort to identify/resolve the transaction with my card issuer and the merchant.
    ✔ My information can be shared with third parties (e.g. merchant, another bank) in order to proceed with the
    investigation for the disputed transaction(s).
    ✔ I agree to receive further communication regarding this dispute claim by electronic means (e.g. e-mail, SMS,etc.)

    Sabrina Challal (Nov 1, 2021 17:40 GMT)


    Signature of Cardholder

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