Reach us at Chorgeback Uni e-mollid : chorgebock@sbi 10th Floor, DLF infinity Tower C, Gurgaon-122002 / fox- 0124 -3992476 d.com SBI Card ae DISPUTE FORM Nome jWofa ChaKpaPan a Mobile / Landine Number i~ 471034 £2. 8&6 SoicudNumber £24) S2Gh 24p LSE tmolld Chalc/e Pani Chaka € yraail Colm, Details of the Disputed Item fs) fironsaction otal Merchant Name /ransaction Amauni[Oisputed Amount] oFfosfoos Lflystyle my Tm_mum Evol 1441-02 799} 00 DECLARATION: | am disputing the transaction (s] listed above for the reason as follows: {1 Duplicate Charge tattach copy of accepted transaction chorgeslip/Ticket booking History for online tronsactions} have been charged twiice for the some transaction on: Hincurred one transaction-dated. ‘ot the above merchant establishment ATM Cash Not Received Cash Not dispensed. Partial amount dispensed by ATM (0 Paid for Goods by Other Means- (Attach copy of cash memo/ bank statement/other bank card statement} [Cosh Cheque / DD/ Credit cord # Dote ‘Ordered Goods or Services not received (Attach copy of order receipt/booking details) Tickets/merchandise not received. Expected Delivery Date: Credit Not Processed (Attach copy of Credit Voucher/Refund note/Merchant’s letter or any form of merchant ‘confirmation that the cradit is duo) Date of Credit Voucher Issuance: cao Billed for No-Show Charge after Cancellation {Attach copy of proof of cancellation) Cancellation Date: Cancellation Number Incorrect Transaction Amount Attach copy of chargeslip/document for the accepted omount) The transaction omount incurred wos ‘but Ihove been billed for 0 Fraudulent Tronsaction(s) (card blocking mandatory) Neither me nor my family members incurred or authorized the above transactions. My card wos lost/stolen on dote____ and was reported to SBI Credit Cords on date otnercomments__Pleee Contel Hp unollerited troneathtin ayreunt fe 7999 | | declore that above given information is true and correct to my knowledge. | understand that I can be held liable for alt charges incurred if dispute roised by me fs found invalid | agree to pay the charges levied by the ‘bank for the some including the cost incurred for investigation of my cloim. By ticking the option for fraudulent transaction(s),| permit SBI Cards to de-activate the card on which the fraudulent transactions) took place, Cardholder's Signoture 2 Charen pone * Please note that a Retrieval Fee of Rs. 25 (plus service tax as applicable) shall be charged per I transaction to your Card Account if case does not close in your favour.