Anexa 17

Scrisoare pentru refuz de plată/ Statement of complaint

Numele Detinatorului/ Cardholder’s name

_________________________________________________
Numarul de card/ Card number
_________________________________________________
Numarul de cont/ Account number
____________________________________________
Numarul de telefon/ Phone number
____________________________________________
Numarul de telefon mobil/ Mobile number
____________________________________________
Adresa e-mail (posta electronica)/ E-mail address
____________________________________________

Motivul disputei/ Subject of dispute:

Eliberare numerar/ Cash Disbursement

Vanzare/ Sales

Card pierdut,furat/ Lost, stolen card

NOTA: Daca investigatiile efectuate de catre Banca vor demonstra ca plangerea

dumneavoastra a fost nejustificata, Banca va debita contul dumneavoastra curent cu sumele
aflate in disputa cu data valutei initiala.
Mentionam ca Banca nu va credita automat contul curent al Detinatorului cu tranzactiile
efectuate de un card pierdut sau furat inainte de data blocarii cardului . Va rugam sa
completati cat mai amanuntit urmatoarele formulare .
NOTE: Should our investigation ascertain that your complaint was unjustified, the credited amounts will
be debited to your account with the original value date .
Please note that automatic crediting will not apply to transaction of stolen cards that are performed
before the blocking time. Please fill in the requested data as detail as you can .
Anexa 17.2
DECLARATIE PENTRU TRANZACTIE DE VANZARE /DECLARATION FOR SALE
TRANSACTION
Numarul de card/Card number_____________________________________________
Tipul tranzactiei disputate/ Type of disputed transaction:

1. Tranzactie la magazin/ Transaction at the shop

2. Tranzactie speciala/ Special transaction
In acest caz va rugam completati declaratiile speciale anexate/The cases mentioned above needs
additional declaration.
Data tranzactiei/ Transaction’s date Valoarea tranzactiei/ Transaction amount

Prin prezenta declar ca…/ Herewith I confirm that…

1. Am semnat pentru suma de _____________________________ , dar am fost debitat cu suma
de ______________________________. I only signed for the amount
of_______________________, but was debited for_________________________.

2. Am fost debitat de doua ori pentru aceeasi tranzactie. I only made one transaction but the
account was debited twice.

3. Suma a fost platita cu numerar. / The amount was paid cash

4. Nu am efectuat, semnat sau autorizat niciodata tranzactia mentionata mai sus. (Va rugam sa
completati Declaratia pentru PIN) / I have never made, signed or authorized the above
mentioned transaction. (Please fill in the PIN declaration)
5. Am fost la fata locului in timpul desfasurarii tranzactiei disputate/ I was on the scene at the time
of the disputed transaction.
Nu/ No

Da /Yes Va rugam sa descrieti locul exact/ Please state the exact scene.

…………………………………………………………………………………………………………………………
6. Cardul era in posesia mea in timpul tranzactiei.
At the time of the transaction the card was in my possession.
Da /Yes

Nu/ No Va rugam sa descrieti motivele/ Please state your reasons briefly

…………………………………………………………………………………………………………………………
7. Serviciul nu s-a prestat, va rugam specificati daca / services not rendered, please specify if

1) clientul nu a beneficiat de servicii / the cardholder didn’t receive the services

2) clientul a fost angajat in tranzactie/ the cardholder was involved in the transaction

3) data la care trebuia sa beneficieze de servicii/the services should be provided on

anul/year |_|_|_|_|luna/month|_|_| ziua/day|_|_|
4) Descrierea serviciilor/ Description of the services

…………………………………………………………………………………………………………………………
8. Cardul nu a fost pierdut sau furat./ My card has not been lost or stolen.
9. Cardul a fost blocat./ Card was blocked.
Nu /No

Da/ Yes Motivul blocarii/ Reason of blocking.

…………………………………………………………………………………………………………………………
10. Modalitatea blocarii si data. prin Call Center prin Sucursala Bancii
Blocking method. Via Call Center at Bank Branch
anul/year |_|_|_|_| luna/month |_|_| ziua/day|_|_|
11. Alte observatii/ Other remarks:
…………………………………………………………………………………………………………………………
Declar pe propria raspundere ca informatiile de mai sus sunt adevarate. / I confirm that the information
provided are true and accurate.
Semnatura Detinatorului ________________________________
Data_______ Cardholder’s Signature
Date
Anexa 17.3
DECLARATIE / DECLARATION

INTERNET, COMANDA PRIN TELEFON/ INTERNET, PHONE ORDER

1. Folosesc regulat internetul: acasa la locul de munca in alte locuri.

I regularly use the internet: at home at work at other places
Daca ati contactat comerciantul va rugam sa scrieti detaliile si concluziile, daca sunt, in sectiunea ‘Alte
observatii’. If you have already contacted the merchant please write down the details and the
conclusions, if any, in the ‘Other remarks’ section.

2. Am comandat bunurile/serviciile prin internet telefon etc comunicand numarul de card.

Data livrarii trebuia sa fie: ………………… Contul a fost debitat, dar pana acum comanda nu a fost
receptionata.
I ordered the good/service trough internet phone etc by giving my card number. The
expected delivery date was: ………………….. My account was debited, but until now there has been no
delivery.

3. Am comandat bunurile/serviciile prin internet telefon etc comunicand numarul de

card. Din pacate, am receptionat ceva diferit decat ceea ce am comandat. Va rugam anexati dovada.
I ordered the good/service trough internet phone etc by giving my card number.
Unfortunately, what I have received was different from I have ordered. Please enclose the proof of
documents.

Am contactat comerciantul: /I have contacted the merchant:

Da / Yes Va rugam sa scrieti raspunsul comerciantului in sectiunea ‘Alte observatii’.
Please write down the merchant answer in the ‘Other remarks’ section.
Nu / No Va rugam sa descrieti motivele in sectiunea ‘Alte observatii’.
Please state your reasons in the ‘Other remarks’ section.

4. Am returnat bunurile comandate prin internet telefon etc comunicand numarul de card.
Data returului: …………………. Va rugam sa scrieti motivele returului in sectiunea ‘Alte observatii’. Va
rugam sa anexati dovada ca bunurile au fost returnate de dumneavoastra si receptionate de comerciant.
I returned the merchandise that I had ordered trough internet phone etc by giving my
card number. Date of return: …………………. Please detail the reasons of return in the ‘Others remarks’
section. Please attached documentation to prove that the merchandise was returned and the merchant
received that returned merchandise.

5. Am anulat comanda periodica, comanda ce a fost facuta prin internet telefon etc
comunicand numarul de card, dar contul meu este debitat. Va rugam sa anexati dovada documentelor.
Data anularii: ……………………….. Metoda anularii: ……………………………..
I cancelled my periodic subscription order, which was placed trough internet phone
etc by giving my card number, but my account is debited. Please enclose the proof of documemts.
Date of cancellation:…………………… Method of cancellation:…………………….

6. Am mai folosit in trecut serviciul mentionat, ultima data la:…………….., dar nu am autorizat tranzactia
specificata deoarece…………………………………………………………………………….
I have previously used the mentioned service, at last time on: ………………., but I did not authorize
the specified transactions, because……………………………………………………………

7.Alte observatii / Other remarks:

…………………………………………………………………………………….…………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………

Declar pe proria raspundere ca informatiile de mai sus sunt adevarate. / I confirm that the information
provided are true and accurate.

Semnatura Detinatorului ________________________________ Data_____

Cardholder’s Signature Date
 Anexa 17.4
DECLARATIE / DECLARATION

HOTEL/ HOTEL

Nu am stat la acest hotel si nici nu am facut o rezervare.

I did not stay in this hotel nor made any reservation.

1. Am anulat rezervarea la hotel pentru …………………(data) in scris la telefon prin

internet.

• Am primit pentru anulare numarul de referinta: …………………………………

I received a cancellation reference number :
• Nu am primit pentru anulare nici un numare de referinta.
I did not receive a cancellation reference number

I cancelled the hotel reservation for ………………..…(date) in writting by phone via

internet.

2. Nu am fost informat despre faptul ca se va percepe o taxa de ‘neprezentare’ in cazul in care nu

anulez rezervarea, sau nu reusesc sa o anulez in timp.
I was not advise by the hotel that “no-show” fee would be charged to my account if I do not cancel
my reservation, or fail to cancel it in time.

3. Valoarea cu care s-a debitat contul meu este mai mare decat valoarea cu care am fost informat in
momentul rezervarii.
The amount debited from my account was higher than the amount I had been told at the time of the
reservation.

4. Am folosit camera si am platit intreaga factura la hotel. Va rugam sa anexati factura si chitanta.
I used the accommodation and I pay all my bill at the hotel. Please enclose your bill.

5. Mi s-a oferit de catre hotel o alta cazare. Numele celuilalt hotel este: ……………………………..
The hotel provided alternate accommodation. The name of the other hotel is:

6. Alte observatii /Other remarks ……………………………………………………………………………….

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

Declar pe proria raspundere ca informatiile de mai sus sunt adevarate. / I confirm that the information
provided are true and accurate.

Semnatura Detinatorului ________________________________ Data_______

Cardholder’s Signature Date
 Anexa 17.5
DECLARATIE / DECLARATION

INCHIRIERI AUTO/ RENT A CAR

1. Contul a fost debitat, dar taxa de inchiriere auto a fost platita cu numerar. Va rugam sa
anexati factura si chitanta.
My account was debited but I had already paid cash the car rental fee. Please enclose
your bill.

2. Contul a fost debitat, dar nu conform contractului. Va rugam sa anexati contractul.

My account was debited, but not in accordance with the terms and conditions of the
contract. Please enclose the whole contract.

3. Autovehicolul a fost returnat in stare perfecta de functionare conform contractului. Va

rugam sa anexati contractul.
The car was returned unharmed and in accordance with the terms and conditions of the
contract. Please enclose the whole contract.

4. Alte observatii / Other remarks:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Declar pe proria raspundere ca informatiile de mai sus sunt adevarate. / I confirm that the information
provided are true and accurate.

Semnatura Detinatorului ________________________________ Data_______

Cardholder’s Signature Date
 Anexa 18

DECLARATIA PIN
DECLARATION FOR PIN
Subsemnatul_______________________________ fiind pe deplin constient de drepturile
mele legale, declar ca, in conformitate cu contractul semnat intre mine si Banca, am folosit
codul PIN al cardului bancar intr-o maniera sigura si nu am dezvaluit nimanui codul PIN al
cardului bancar, asa cum este mentionat in contractul cu Banca.
I the undersign being fully aware of my legal liability declare that, in accordance with the
contract between the Bank and myself, I have been handling the PIN of the bankcard in a
secure manner with due diligence and I did not disclose the PIN to anybody as it is described
in the terms and Conditions

Va rugam sa completati / Please mark the appropriate answer:

1.Am distrus plicul cu codul PIN/ I have destroyed the PIN envelope as well as the PIN paper
after reading my PIN

DA/ YES NU/NO

2. Pastrez acasa plicul cu codul PIN/ I keep the PIN-envelope with the Pin at home:

DA/ YES NU/NO

3. Pastrez plicul cu codul PIN la mine( in servieta, in geanta)/ I have the PIN-Envelope and
the Pin with me( in my suitcase , in my brief case):

DA/ YES NU/NO

4. Am scris codul PIN sau versiunea incodata a acestuia in calculator, cellular, notebook)I I
recorded the Pin or its encoded version( in my desktop, my mobile phone, my notebook):

DA/ YES NU/NO

5. Am dezvaluit codul PIN familiei sau prietenilor/ I disclosed the PIN to my Family or my
friends:

DA/ YES NU/NO

Declar pe proria raspundere ca informatiile de mai sus sunt adevarate. / I confirm that the information
provided are true and accurate.

Semnatura Detinatorului ________________________________ Data_______

Cardholder’s Signature Date