Reoch us at Chargebock Unit, 10th Floor, DLF Infinity

Tower C, Gurgoon-122002 / toy- 0124-1992476

e-mail id chorgebockesbicord.com

SBI Card DISPUTE FORM

CHAN3RA hSERPobile/ Lordinetumbey 242C 722710
Nome 2 umESIH Emol id
Ume ihgnnidriast re
SBI Cord Number 4591 SL0 3346 1EO6
Oetoils of the Disputed tem (s)
Merchont Nome
Tronsoction Dote Tronsoction Amour Dspted Amort
27/c 2ac22 FLIP K ART
S6,637 sc, C27/

transoction ls) isted above for the reason os follows:

DECLARATION Iam disputing the
for anline
Duplicate Charge (Attoch copy ofaccepted transaction chargeslip/Ticket booking History
transoctions)
charged twice for the same tronsoction
on:
Ihove been
i ncurred one transoction-dated at the above rmerchant estoblishrment

ATM Cosh Not Received

Cash Not dispensed
Partial amount dispernsed by ATM
Means- (Attach copy of cosh memo/ bank statement/other bank card stotement
OPaid for Goods by Other
Cheque / DD/ Credit cord #Ges6li payDate 2 7 / c q / 2 0 2 2
Cosh
Ordered Goods or Services not received (Attoch copy of order
receipt/booking details)
Tickets/merchiandise not recerved. bpected Delivery Dote.
any form of merchant
OCredit Not Processed Attoch copy of Credit Voucher/Refund note/Merchant's letter or

confirmation that the credit is due)

Dote of Credt Voucher issuonce

Billed for No-Show Chorge after Concellation Attoch copy proof

of of cancellation)
Conceliaton Date Concellaton Nurmber
for the occepted amount)
Incorrect Tronsoction Amount (Attoch copy of chargeslip/document
but i hove been billed for
The tronsoction omount incurred wos

OFraudulent Tronsoctionls) (cord blocking mondatory)

obove transoctions
Neither me nor my fomily mernbers incurred or outhorized the
dote
andwos reported to SBI Credit Cords
on
Mycord wos lost/ stolen on dote
Other Comments- ferlyle pary
I deciore that above gven informoton ond correct to my knowledge lunderstond thot can be held
is true i
invalid I ogree to poy the chorges leved by the
liable for all chorges incurred f dispute roised by rne is found
bonk for the sorne including the cost incurred for investugoton of my clarn By ucking the option for froudulernt
transoctionls), I permit SEi Cords to de-ytivote h e card on which the fraudulent tronsoctionisi took ploce

Cordholders Signoture

Please note that a Retrieval Fee of Rs. 225 (plus service tax as opplicable) shall be charged per
transaction to your Card Account if case does not close in your favour.
 Reach us at Chorgebock Unit, 10th Floor, DLF Infinity Tower C, Gurgaon-122002 / fax 0124 -3992476
e-mail id: chargeback@sbicard.com

SBI Card
Mote Fe simp
DISPUTE FORM
Nome R UMES CHANDRA M1SHRAMobile/ Londline Number 8 480 2271o
SBI Cord Number Email id m eshgariD Gmaili com
s q / s a 33Y6 18066
Details of the Disputed Item (s)
Merchant Nome Transaction Amount Disputed Amount
TronsactionDate
R O2 FLIP KART s6,6 37 sC,C31

DECLARATION: I am disputing the transaction (s) listed above for the reason as follows:

O Duplicote Charge (Attoch copy of accepted transaction chargeslip/Ticket booking History for online
tronsoctions)
I have been charged twice for the same transaction on:
I incurred one transoction-dated at the above merchant establishment

OATM Cash Not Received

Cash Not dispensed
Partiol omount dispensed by ATM

O Paid for Goods by Other Means-(Attach copy of cash memo/ bank statement/other bank card statement)
Cash Cheque/DD/ Credit card #os6Le pay_Date 27/oq/ 2022
Ordered Goods or Services not received (Attach copy of order receipt/booking details)
Tickets/merchandise not received. Expected Delivery Date:

a Credit Not Processed (Attach copy of Credit Voucher/Refund note/Merchant's letter or any form of merchant
confirmation that the credit is due)
Date of Credit Voucher Issuance:

Billed for No-Show Charge after Cancellation Attach copy of proof of cancellation)
Cancellation Dote: Cancellation Number

O Incorrect Transaction Amount (Attoch copy of chargeslip/document for the accepted amount)
The tronsoction amount incurred was but I have been billed for

Fraudulent Transactionls) (card blocking mandatory)

Neither me nor my fomily members incurred or authorized the above transactions.
My cord was lost/ stolen on date. and was reported to SBI Credit Cards on date.

Other Comments

declore that above given information istrue and correct to my knowledge. I understand thatI can be held
liable for all charges incurred if dispute raised by me is found invalid. I agree to pay the charges levied by the
bank for the same including the cost incurred for investigation of my claim. By ticking the option for fraudulent
transoctionls), I permit SBI Cards to de-tivate the card on which the fraudulent transactionls) took place.

Cardholder's Signature t ,al2

Please note that a Retrieval Fee of Rs. 225 (plus service tax as applicable) shall be charged per
transaction to your Card Account if case does not close in your favour.