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CARDHOLDER DISPUTE FORM To The Manager HDFC Bank Cards Division PO Box No. 8654 Thiruvanmiyur P. O. Chennai 600041. NAME CREDIT CARD NUMBER I am disputing the following transaction s for the reason given below and request you to settle the case s DETAILS OF DISPUTED ITEM S TRANSACTION DATE MERCHANT NAME TRANSACTION AMOUNT Please select the most appropriate one I have neither authorized nor participated in the above transaction s. I confirm that the card is still in my possession* My card was lost/stolen on and the same was reported to you on. Duplicate/Multiple billing. I have done only one transaction at the Merchant Establishment but I was billed times. Attach copy of authorized chargeslip I have cancelled the transaction s /returned the goods but have not received credit/refund for the same Attach Credit Voucher/Refund note/Merchant s letter or any form of merchant s confirmation that the credit is due to the card account I had received defective merchandise/goods and had returned the goods to the merchant. Attach Credit Voucher/Refund note/Merchant s letter or any form of merchant s confirmation that the credit is due to the card account Paid by alternate means. First I gave my card for payment but later on paid by other means for the same transaction* I Paid by Cash attach cash receipt/bill / Cheque attach Cheque receipt/Bank statement / other card attach chargeslip/other card statement Cancelled Membership/Subscription/Booking. Attach the proof of merchant acknowledging the cancellation I ordered goods/services and the same were expected to be delivered by date dd/mm/yy but I never received the same. Attach the proof of merchant acknowledging the cancellation The transaction amount incurred/authorized by me is for Rs. but I was billed for Rs. Attach copy of authorized chargeslip Cash was not dispensed at the ATM but I was billed for the entire amount of Rs. Cash was dispensed partially in the ATM for Rs. but I was billed for the entire amount of Rs. Others Please explain in detail* Please attach a separate letter if necessary I declare that above given information is true and correct to my knowledge. I understand that I 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* The Bank may contact me whenever it requires any further information* Email/Phone / Fax Cardholder s Signature Date Add-on Cardholder s Signature If any. Chennai 600041. NAME CREDIT CARD NUMBER I am disputing the following transaction s for the reason given below and request you to settle the case s DETAILS OF DISPUTED ITEM S TRANSACTION DATE MERCHANT NAME TRANSACTION AMOUNT Please select the most appropriate one I have neither authorized nor participated in the above transaction s. I confirm that the card is still in my possession* My card was lost/stolen on and the same was reported to you on. I confirm that the card is still in my possession* My card was lost/stolen on and the same was reported to you on. Duplicate/Multiple billing. I have done only one transaction at the Merchant Establishment but I was billed times. .

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