Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 2

31/F UNIONBANK PLAZA

MERALCO AVE. ORTIGAS CENTER


PASIG CITY 1650

DISPUTE FORM
Attention: UNIONBANK CUSTOMER SERVICE
Fax Number: 02 636-6256
Email: customer.service@unionbankph.com
Please complete this form & attach the copy of the card's front and back image together with any other pertinent
documentation and send them to any of the channels by mail, fax or email. These documents are required prior to
processing your dispute in accordance with the chargeback conditions as outlined by Visa. If we do not receive these
requirements within the timeframe specified above, the disputed transaction(s) will be considered valid. Processing time is
15-85 calendar days.

ALL INFORMATION MUST BE LEGIBLY PRINTED OR TYPED


Name
Card Number
AccountNumber
Home Number
Office Number

Cely Rose J. Caliao

Mobile Number

09175647244

4404528832722205
Fax Number
Email Address
Mode of Confirmation

Coo_ky919@yahoo.com
Email
Fax
(Text)

X SMS

To confirm receipt of your dispute letter and supporting docs, please indicate your preferred mode with
a () tick mark.

PLEASE INDICATE THE DETAILS OF THE DISPUTED TRANSACTIONS


Transaction Date
August 21, 2014

Merchant Name
Ayala Malls

Disputed Amount
P810

Based on my examination of the Billing Statement of my credit card account and/or enquiry with your Customer Service, I am
disputing the item/s listed above based on the following: (Please tick the most appropriate description)

Multiple/twice charged for the same transaction


Unauthorized/Unrecognized transaction
Incorrect Transaction Amount
Correct Amount:
___________________
XCancelled transaction
Date Cancelled:
August 21, 2014_______
Services Not Rendered (Defective or Returned Product, Undelivered Item)
Paid Through Other Means (Please enclose receipt to prove other method of payment)
Lost/Stolen Card
Date Card Reported as Lost/Stolen: ______________________
Others (provide detailed explanation)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Signature ________________________________

Date _September 27, 2014___________

Note: For Lost/Stolen card dispute, copy of front and back image of card is no longer required.

You might also like