Transaction dispute form

For each dispute, you must fill this form, selecting only one associated reason, and return to us a signed digital copy through the
sumupcard@sumup.com, attaching the supporting proof(s) when required. Please, have in mind that a detailed description of the
case is mandatory. Failing to comply with these requirements might render the case as void.

First Name Dayana Andrea Surname Torres morales

Card Number Digits 5 2 9 1 3 3 ******** 7 4 1 0

Merchant Details (can be found in SumUp
ZARA MADRID GRAN VIA 3MADRID ES
Card transaction history)
Transaction Transaction Currency and Amount
Date(dd/mm/yy) 1 0 0 3 2 4 22.95 EUR

☐ Duplicated transaction ☐ Free trials: if you authorized charges related to

a trial offer and unless you cancel it, company
Card terminal receipt confirming the transaction was rejected
will continue to debit your account and provide
(not mandatory). you the goods.

(provide all items applicable & tick box to confirm item enclosed)

☐ I have not, or will not receive the service / product

for the transaction(s)
Customer must return the goods to your retailer by
registered post and enclose to this form a copy of the
associated post receipt.
(provide all items applicable & tick box to confirm item enclosed)

Copies of any correspondence (e-mails or letters) you

Proof that the you have tried to solve the issue with your
have with your retailer.
retailer.

Proof of the purchase (copy of receipts, invoices or e-mail

confirmation). If none available, please confirm this in
☐ Other cases (e.g. car rentals or hotel
reservations, ATM cash not dispensed)
writing.
(provide all items applicable & tick box to confirm item enclosed)
Liquidation notice or proof that you will not receive the
merchandise. (email or letter from your retailer).
Proof that you have tried to resolve the matter with your
retailer.

☐ Recurrent payments I have cancelled are still being

charged to my SumUp Card
Copies of receipts, invoices, e-mail confirmation,
agreement or contracts.
(all documents requested must be provided)
Unauthorized transaction. I certify that the
Proof of cancellation (copies of e-mails, protocols or letters).
☐
✔ mentioned transaction was NOT made or
authorized by me, nor did I authorize anyone
else to do this.
☐ An agreed refund was not processed after 30 days
(provide all items applicable & tick box to confirm item enclosed) ☐ 1. Card was in my possession and I
have not authorized anyone to carry
Proof of promise of refund, showing the amount and out payments on my behalf, OR;
estimated date
☐
✔ 2. Card is NOT in my possession
(stolen, lost or never received)
In case of stolen or lost card, attach a copy or proof of
related report.

SumUp Limited
Bloc 8, Harcourt Centre, Charlotte Way
Dublin 2, Dublin, D02 K580, Ireland
 Transaction paid by other means (cash, bank
☐ transfer, cheque, voucher, another card)
Enclose a copy of the proof of payment made by another
mean.
Incorrect amount or currency. The transaction
☐ billed by the Merchant was different from the
sales draft or documents that I had authorized.
Enclose a copy of the sales draft or agreement.

Dispute Details:
Please, describe here your complaint in sufficient detail, enabling all parties to understand the dispute:

my card has been stolen and they made several payments with my sumup card, the same day I
was robbed 10 March I lost other cards.

Please, note that there are strict timeframes and standards laid down by MasterCard International to issue and handle a transaction dispute request. To this
end, you must contact us without undue delays after each communication or document request.

I certify that the above information and enclosed proofs are accurate to the best of my knowledge.

Signature Date

SumUp Limited
Bloc 8, Harcourt Centre, Charlotte Way
Dublin 2, Dublin, D02 K580, Ireland