Transaction Dispute From / January 2019

TRANSACTION DISPUTE FORM

Important Reminders:
 If you are disputing an unauthorized or unrecognized transaction, please immediately call our 24/7 Customer Service hotline
at (02) 88-791-88 to have your card blocked and replaced.
 Kindly accomplish this form and attach all necessary documents to support your dispute claim.
 Please complete one form for each disputed transaction if dispute types are different in nature.
 Investigation of the disputed transaction/s may take up to 40 banking days.
 Please note that we will only be able to proceed with the dispute process if the requirements are complete.
Email Address: Deposit/Debit Card Account: customercare@securitybank.com.ph

Account holder’s Name _________________________ Date ______________________

Account holder’s Signature _________________________

Card Number
(16-digit Card number)
Or
Account Number
(13-digit account number)
Transaction Date Posting Date Establishment/Merchant Name Amount

I am disputing the above transaction/s for the following reason: (Please tick one box only)

 Credit or refund not processed / Cancelled transaction/s.

Request for refund for cancelled transaction or returned goods not yet processed.
Requirement (Any of the following): Copy of Credit Transaction Receipt / Cancellation or Void Memo

 Services not rendered

Merchant failed to render service without prior notice of cancellation as agreed by both parties. Services were to be
provided on (mm/dd/yy) ____/____/____.

 Paid by other means: Cash ____/ Others ____ (Please put a check mark)
The transaction was settled through another form of payment (i.e. cash, check, or another other credit card).
Requirement: Copy of Proof of payment (i.e. cash receipt, transaction receipt)

 Duplicate billing
Cardholder was debited twice for the same transaction.

 Others (If none of the above is applicable)

Please provide complete description of your dispute.
__________________________________________________________________________________________

I hereby declare that all information provided in this Transaction Dispute Form is true and correct. Should the dispute be found invalid,
I agree that Php400 shall be charged to my account for every sales slip retrieval made during the investigation. Disputed transaction
shall be subject to investigation by Security Bank Corporation (“Bank”). The Bank is hereby authorized to automatically, without need
of any further notice, debit/credit the account in accordance with the result of investigation.