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Dispute Claim
Dispute Type
Select dispute type
Account Holder's Name
Account Number
Transaction Date
Claim/Dispute Amount
Transaction Bank/Merchant
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Please tick on below dispute options as appropriate:
Any other information (please specify)
Declaration
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)
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