Debit Card Dispute Form

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

CARDHOLDER DISPUTE FORM

Card Number Date

_ _ _ _ X X X X X X X X _ _ _ _ (First and Last Four Digits ONLY)

TRANSACTION/S FOR DISPUTE

Sale Date Post Date Merchant Name/ Transaction Description Amount

Total

REASON/DISPUTE TYPE

Please select the most applicable reason/dispute type and provide the document/s required. Also indicate the document/s submitted
immediately below the reason/dispute type.

Via ATM (BancNet or Megalink)

Via ATM (EastWest Bank ATM machine)

VISA – Unsecured Transactions (Transactions with International Merchant)

VISA – Secured Transactions (Transactions with Local Merchant)

POS Transaction

Others (please provide detailed explanation on the space below)

In making this complaint, I hereby declare that:

My card has always been and remains to be in my possession and has not been reported lost/stolen

My card has been reported lost/stolen

The circumstances I have stated herein are true and correct and the documents I have submitted are authentic or duly issued.

By sending this form, I understand the following:


 Investigation may take 60 banking days; and
 Dispute transaction will be processed upon receipt of complete documents.

Please send this form through fax at 830-8900 or e-mail at [email protected].

«Cardholders_Name»
SIGNATURE OVER PRINTED NAME
EW Form 8-059 Rev 1/2015 CONFIDENTIAL

You might also like