ORIENTAL BANK OF COMMERCE

(A Government of India Undertaking)

H.O.: Plot No:5, Institutional Area, Sector-32, Gurgaon

CHARGEBACK FORM
The Branch Incumbent Date:______________
Oriental Bank of Commerce,

Dear Sir,
Re: Chargeback for ATM TXN / POS TXN / E-COMMERCE TXN (Online purchase using ATM debit card)**
I am submitting herewith the claim for unsuccessful transaction performed as per the details below.

1. CUSTOMER's NAME: ______________________________________________________________

2. CARD No:

3. ACCOUNT No:

4. Debit Card transaction details:

S.No Card Transaction ATMID/ POS TXN / Ref TXN TXN Dispute Resp. IDEAS Complaint
(TXN) Type ID/Web Site No Date Amount Amount Code No (For Bank use)
1 ATM/POS/E-Com

2 ATM/POS/E-Com

Additional Information for POS (Point of Sale) TXNs.

5. POS Owner Bank:______________________ Merchant details/Location: _____________________________
Paid for goods by other means (Cash/Swiped again/ used alternate card for payment card, Cheque/DD/ etc if any)
Additional information for E-Commerce TXNs.**
6. I ordered goods/services and the same are expected by Date ________. But I never received the same.
I contacted the merchant on Date __________. Correspondence and response received from them is enclosed.

I/We hereby agree to indemnify the Bank in case, if the subject Chargeback is REPRESENTED/REJECTED by the
acquiring Bank. I/We understand that resolution of this chargeback shall take 7 working days for ATM TXN and
maximum 45/30 working days for VISA-POS & E-commerce / Rupay POS.
Signature of Cardholder___________________________ Address:__________ ___________________________
Email id: _______________________________________Tel.No/ Mobile No______________________________

** E-Commerce transactions like verified by VISA(VBV), RUPAY E-Commerce etc. , the customer invariably needs to first
contact the merchant and attempt to resolve the dispute.

Office Use for CHARGE BACK receiving Branch, B/O:____________________Sol Id:______

We have verified the above mentioned particulars in Finacle and hereby confirm that the card holder's A/c has been
debited on account of the subject transaction as per TRAN ID appended below and System/Branch has not reversed the
entry so far. The details as per Finacle are given below:
S.No Tran Id Tran Dt Value Dt Finacle Remarks Finacle Ref No
1
2
** In case of POS/E-commerce TXN,Correspondence made by the customer with the merchant is to be sent to Email id:
copec@obc.co.in & for ATM txn Email id: coc@obc.co.in / obcchbk@obc.co.in or Fax No 040-66318561

Signature & Name__________________P.A. No. _____________ Date of Entry in IDEAS_________________

of Authorized official Note for POS TXN Paid for goods by other means is to
be entered in IDEAS remarks field invariably

For any help with respect to ATM TXN/ATM card /POS TXN/E-Commerce TXN you may contact on unified
Toll Free No: 1800-180-1235 or 0124-2340940 of our 24 hrs Banks call centre.