BORANG ADUAN PINDAHAN DANA ELEKTRONIK

ELECTRONIC FUNDS TRANSFER GRIEVANCE FORM

Tarikh & Masa Laporan 2 5 / 1 0 / 2 0 2 1
Date & Time of Report
HH / DD BB / MM TT / YY Jam/Min / Hour/Minute

MAKLUMAT PELANGGAN / CUSTOMER’S INFORMATION

Nama J A M I S B I N K U N A N G
Name
No. K.P./Pasport 7 7 0 6 0 5 1 2 5 0 5 1 Jantina
x Lelaki Perempuan
IC/Passport No. Gender Male Female
Alamat
Address l o t 7 8 , l o r o n g b a y u i d a m a n 4 . T a m a n B a y u
i d a m a n , J a l a n s h a b a n d a r T u a r a n
Poskod 8 9 2 0 8 Alamat E-Mel james .kunang@gmail.com
Postcode E-Mail Address
No. Telefon (Bimbit) 016 No. Telefon (Rumah/Pejabat)
Telephone No. (Mobile) 8 1 8 9 9 1 3 Telephone No. (House/Office)

MAKLUMAT AKAUN/KAD / ACCOUNT/CARD INFORMATION Sila tandakan mana yang berkenaan/Please tick whichever is applicable

Nombor Akaun/Kad
Account/Card Number
x Simpanan 6 8 4 4 8 0 6 8 0 3
Savings

Semasa
Current

Simpanan Tetap
Fixed Deposit

Pinjaman
Loans
(No. Nota Pinjaman / Loan Note No.)
Kad Kredit/Debit
Credit/Debit Card

Kad Debit PB Lifestyle/PB RCB Gold/PB RCB Elite/Kad PB Corporate MyDebit

PB Lifestyle/PB RCB Gold/PB RCB Elite Debit Card/PB Corporate MyDebit Card

SALURAN SERAHAN / DELIVERY CHANNEL Sila tandakan mana yang berkenaan/Please tick whichever is applicable

ATM Mesin Tunai Kitar Semula (CRM) Perkhidmatan PBe Pindahan Dana Elektronik di Tempat Jual Terminal Wang Masuk (CDT)
ATM Cash Recycling Machine (CRM) x PBe Service Electronic FundsTransfer at Point of Sale Cash Deposit Terminal (CDT)
EMV POS (Sila lengkapkan Surat Pertikaian untuk Kad Visa/MasterCard/ATM) Lain-lain
(Plese complete the Letter of Dispute for Visa/MasterCard/ATM Card) Others

BENTUK ADUAN (Sila masukkan ke dalam CGS dengan segera) Sila tandakan mana yang berkenaan/Please tick whichever is applicable
NATURE OF COMPLAINT (Please input into CGS immediately)

Dana tidak diterima Dana tidak dibayar kepada benefisiari Akaun didebitkan tetapi tunai tidak dikeluarkan Percanggahan semasa penerimaan dana
Non-receipt of fund Non-payment of fund to beneficiary Account debited but cash not dispensed Discrepancies on receipt of fund

Wang tunai tersekat di CDT/CRM / Dana tidak dikredit Jumlah yang sepatutnya ialah dan bukannya
Cash jammed at CDT/CRM / Non credit of fund Amount should be instead of

x Lain-lain (sila nyatakan) telah memindahkan wang kepada akaun yang salah
Others (please specify)
Tempat Urus Niaga Tarikh Urus Niaga 21/10/2021 Masa Urus Niaga 06:26:24 am
Transaction Location
pbe online Transaction Date Transaction Time
Nombor Rujukan 424649 Nombor Terminal
Reference Number Terminal Number
Butir-butir Percanggahan:
Discrepancy Description Jamis Bin Kunang
Tandatangan Pelanggan/Customer’s Signature
PERAKUAN PENERIMAAN KEPADA PELANGGAN / ACKNOWLEDGEMENT TO CUSTOMER
(Tidak berkenaan bagi EMV POS/Pertikaian ATM Luar Negara / Not applicable for EMV POS/Overseas ATM Dispute)

Kami mengaku menerima laporan di atas dan akan memaklumkan kepada anda hasil siasatan kami dalam masa 14 hari.
We acknowledge receipt of the above report and will inform you of the outcome of our investigation within 14 days.

Tandatangan Pegawai Bertugas Tarikh/Date Untuk perhatian Pengurus/Pengurus Perkhidmatan Tarikh/Date

Signature of Attending Officer Perbankan / Noting by Manager/Banking Services Manager
Nama/Name: Nama/Name:
Cawangan/Bahagian Ibu Pejabat:
Branch/Head Office Department

UNTUK KEGUNAAN BANK SAHAJA / FOR BANK USE ONLY

Kaedah Penerimaan Telefon Surat Hadir Sendiri Catatan / Remarks:

Mode of Receipt Telephone Letter In Person
Tarikh / Date Masa / Time

Nombor CGS / CGS Number

PUBLIC BANK BERHAD (6463-H) FORMS/EFT001/REV230519

PUBLIC ISLAMIC BANK BERHAD (14328-V)