Dispute declaration form.indd

Dispute Declaration Form
All information is required unless stated.
1
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
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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)
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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
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I attach supporting documents of the purchase or transaction.
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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) /
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at (time)
and the cancellation code given to me by the hotel or reservation agent was
Others (Please describe your dispute)
4 Your signature
Date
5 What to do next
Send by Fax
Customer
Resolution Team
+65 6830 7943
OR
Send by E-mail
Attn: Customer
Resolution Team
[email protected]
OR
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.
Co.Reg.No:193299932W
DDF Contact Centre
Card holder’s signature