Letter of Dispute for Visa/MasterCard/PB Day2Day Card

Public Bank Card Services

10th Floor, Menara Public Bank
146, Jalan Ampang
50450 Kuala Lumpur
(Fax No : 603-21639400)

Name of Cardholder :

Visa/MasterCard/PB Day2Day Card No.* :

I wish to dispute the following charge(s) that has / have been billed to me (list charges individually below, or attach statement and
circle disputed items) :-

No. Transaction Date Merchant Name Amount (RM)

I am disputing these charges on the basis that :

(please tick where appropriate and attach supporting documents as required)
I do not recognise the Merchant Name / Location / Transaction Amount / Transaction Date / Others *.
For others, please specify :-

I participated in one transaction at the same merchant location. However, I did not engage in nor authorize the transaction in
question, and my card was in my possession and control at the time of the disputed transaction(s).
(Please enclose a copy of the acknowledged Transaction Receipt at the same merchant location)
I certify that the charge listed above was not made by me or by a person authorized by me, nor the merchandise / services *
represented by the above transaction was received by myself or a person authorized by me.

I did not receive credit for the enclosed credit voucher.

(Please enclose a copy of the Credit Transaction Receipt, Credit Note, or Merchant Acknowledgement Letter for a refund)

The amount of the transaction receipt was altered from _____________ to _____________ .
(Please enclose a copy of the Transaction Receipt prior to the alteration)

I have been billed more than once for the same transaction.
(Please enclose a copy of the acknowledged Transaction Receipt at the same merchant location)

I have paid in full by cheque no. :____________ Bank _______________ , or cash RM __________________ , or other
credit card.
(Please enclose a copy of proof of payment, e.g. Transaction Receipt, Cheque or Credit Card Statement and evidence of
attempt to resolve with the merchant for e-commerce and services related transactions)

I have notified the merchant to cancel my monthly / quarterly / annual* billing on __________________ . Since then, my
account has been charged _____________ times. (Please enclose a copy of the cancellation letter to merchant and
evidence of attempt to resolve with the merchant for e-commerce transactions)

The merchandise / services* received does not conform to the written characterization provided.
(Please enclose a copy of documentary proof containing a written description of the merchandise or services purchased and
an explanation letter and evidence of attempt to resolve with the merchant for e-commerce and services related transactions)

I have returned the merchandise / cancelled the services* on _____________________.

(Please enclose a copy of proof of the merchandise returned or services cancellation letter to merchant, explanation letter
and evidence of attempt to resolve with the merchant for e-commerce and services related transactions)
I have not received the merchandise nor services for the above transaction. The expected delivery / services* date was
______________ . (Please enclose a copy of the document on expected arrival date of the merchandise or services
expected date and evidence of attempt to resolve with the merchant for e-commerce and services related transactions)

Others, please specify :- ______________________________________________________________________________ .

Signature : Date:
Identity Card No :
Contact Number :
* Please delete where not applicable.
Letter of Dispute for Visa/MasterCard/PB Day2Day Card FORMS/ATM046/REV200611