Dispute Inquiry

Card Type Credit Card Debit Card

Credit Card

Card Number

Cardholder's Name

Address

City

Country

Mobile Phone

Home Phone

Statement Date

Item Amount in US$

Reference Number (as appears on your statement)

Merchant Name

File Uploads

Copy of cardholder’s Passport or ID.

Copy of sales draft, POS receipt.

Any documents related to the dispute e.g., sales receipt, merchant agreements, conversation with merchant etc.

A dispute fee of USD$10 will be charged to your Credit Card account in order to initiate our investigation.

MasterCard Debit Card

Card Number

CIF

Cardholder's Name

Address

City

Country

Mobile / Home Phone

Email Address

Transaction Date

Item Amount in XCG

Merchant Name

File Uploads

Copy of cardholder’s Passport or ID.

Copy of sales draft, POS receipt.

Any documents related to the dispute e.g., sales receipt, merchant agreements, conversation with merchant etc.

Any negligence or non- compliance by the cardholder to dispute any fraudulent or unknown transaction within the stipulated timeframe will be the cardholder's responsibility.

Cardholder Dispute Form – Credit/Debit Card

Please check/cross the appropriate box below and complete all required fields.
Upload the following supporting documents where applicable:

- A copy of your ID
- A copy of your card statement
- A copy of the sales receipt
- A copy of the credit slip (if available)

Important Notice: Any failure by the cardholder to dispute fraudulent or unknown transactions within the stipulated timeframe will be the sole responsibility of the cardholder.

Select the reason(s) for your dispute

Unauthorized Transaction – The charge(s) were not made by me or anyone authorized to use my card.

Payment Not Posted – My payment did not post. (Upload proof of payment such as a cancelled check or money order.)

Credit Not Posted – A credit was not applied to my account. (Upload credit slip with account number, merchant name, date, and amount.)

Duplicate Charge – I was charged twice for the same transaction. (Provide transaction details.)

Merchandise/Services Not Received – I did not receive the goods or services. (Describe resolution attempts and expected delivery date.)

Overcharged – I was charged more than the agreed amount. (Upload signed sales receipt.)

Merchant Refused Credit – The merchant declined to issue a credit. (Upload sales slip and store credit. Note: In-store credits or “no refund” policies may affect eligibility.)

Sales Draft Request – I request a copy of the sales draft. (Provide transaction details and reason.)

Hotel/Timeshare Cancellation – I was charged for a cancelled reservation. (Provide cancellation number or name of person who confirmed cancellation.)

Unauthorized Reservation – I was charged for a reservation I did not make or authorize.

Credit Processed as Sale – A credit was incorrectly processed as a sale. (Upload credit slip and original charge date.)

Defective Merchandise – The item received was defective or damaged. (Describe issue, return attempts, and merchant response.)

Returned Merchandise – I returned the item but did not receive a refund. (Describe return details and upload postal receipt or credit slip.)

Cancelled Service/Membership – I cancelled a service or membership. (Upload cancellation letter or note date of cancellation call.)

Service Dispute – I am disputing a service. (Describe issue and resolution attempts. Must exceed USD $50/XCG 90 and be local unless mail/phone order. Upload supporting documents. Disputed amount must remain unpaid.)

Other – (Please describe clearly. You may upload additional documents if needed.)

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