Dispute Claim

  • I used my Debit/ Credit card to perform transaction. However, the transaction was unsuccessful/declined & my account was debited
  • Mentioned transaction was charged to my account more than once
  • I had paid by other means or purchase was cancelled
  • The amount billed by Merchant was different from Sales draft or documents that I have authorized
  • Unauthorized transaction - I did not authorize or participate in the transaction(s) mentioned above or authorized anyone to engage in the transaction(s). At the time of this transaction the card was in my possession
  • Any other information (please specify)
I hereby declare that the above facts are true. It is understood that in case of any error, the bank shall be within its right to rectify the error unilaterally without notice to me/us and recover any amount wrongly paid/credited along with other transaction and fees. Further, I authorize the bank to debit my account by the reversed amount if the transaction is found successful and the acquirer/merchant makes a presentment/claim for the transaction(s)
Helpdesk - NIC Asia Bank

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