Dispute declaration form.indd

Dispute Declaration Form
All information is required unless stated.
For credit card transaction disputes
Your details
Name of card holder
Contact number
Card number (which the disputed transaction(s) was charged on)
2 What transactions are you disputing?
Transaction date
DD / MM / YY
Merchant’s name
Amount in SGD
I would like to request for the sales draft copy for the above transactions.
I understand that SGD 15.00 will be deducted from my account for retrieving it.
3 Why you are raising this dispute:
Tick one only
Unauthorised transactions
I did perform the transaction on (date)
but NOT the other transaction(s). My card was with me at all times.
at (merchant)
for (SGD)
The transaction(s) was/were paid by cash or cheque or another card. I attach the receipt.
I did not perform these transaction(s). My card was with me at the time of the transaction.
I did not authorize anyone to sign transaction receipt/s for me.
I have only made one transaction. The above transaction(s) is/are duplicate(s).
Service related
I have cancelled my recurring payment instruction with the merchant but my account is still being deducted.
I attach a copy of my cancellation letter to the merchant.
I have not received the merchandise or service that I have paid for and have attempted to resolve this with the merchant.
The expected delivery or service date was
I attach supporting documents of the purchase or transaction.
The merchandise or goods received were broken or defective or not as described. I have returned it on
I have attempted to resolve with the merchant. I attach proof of return or shipping note.
I have cancelled the hotel reservation on (date) /
at (time)
and the cancellation code given to me by the hotel or reservation agent was
Others (Please describe your dispute)
4 Your signature
5 What to do next
Send by Fax
Resolution Team
+65 6830 7943
Send by E-mail
Attn: Customer
Resolution Team
[email protected]
Send by mail
Customer Resolution Team
CFS Contact Centre, 65 Chulia Street,
#14-00, OCBC Centre, S049513
We will take up to 12 weeks to investigate this matter and a letter will be sent to you thereafter.
DDF Contact Centre
Card holder’s signature