Axis Bank Dispute Form – Fill Out and Use This PDF

Under Axis Bank Customer, mark Yes or No.

Enter the Cardholder's Name, Contact Number and Email.

Enter the Debit/Credit/Forex Card number.

Enter the Axis Bank Account Number (Applicable For Debit Cardholders only).

Under Details of Disputed Transaction/s, enter the Sr., Transaction Date, Merchant Name/ATM Location, Transaction Amount & Currency and Disputed Amount & Currency.

Mark the issue as per applicable.

Duplicate/multiple billing: you have done only one transaction but you were billed Twice/Thrice etc; write that in the blank.

The Goods/Services rendered by the Merchant are not as described: the item/s purchased or service/s paid for do not conform to what was agreed to have been supplied by the merchant or was defective. Specify what good/s or service/s were expected and what were actually delivered. If you have returned the merchandise to the merchant, provide proof of return, such as postal/courier receipt and correspondence with the merchant.

I had tried transaction online, the same was not successful but the amount was debited from my account.

Cash not dispensed in ATM but I was billed for the entire amount.

Less cash dispensed in the ATM: provide the Amount & Currency of the less cash and the Amount & Currency of the entire amount you were billed.

Transaction cancelled and I have not received the credit/ refund for the same: attach credit slip/refund note/merchant's letter or any form of merchant's confirmation that the transaction was cancelled and the credit was due to you.

Paid by other means: attach cash receipt/bill, cheque receipt/bank statement or other card chargeslip/other card statement.

Cancelled membership/Subscription/booking: attach the cancellation letter which you sent to the merchant.

I ordered goods/services and the same are expected by Date (dd/mmm/yyyy), but I never received the same; correspondence with merchant for order status is required.

The transaction amount is the Amount & Currency you provide, but I was billed for another Amount & Currency you provide.

I have not participated or authorized the transaction(s) in Details of Disputed Transaction/s. The card was in my possession at all times.

Hotel Reservation: (A) I have cancelled the Reservation; fill in The Cancellation Date being and the Cancellation Code is; (B) I have not made or authorized any reservation/s or availed of the services.

Others: please explain in detail, and please attach a separate letter if necessary.

Under Declaration, fill in Place and Date and sign on Customer Signature.

I hereby confirm that the averments made by me within this form are bona-fide and the information provided is true and accurate to the best of my knowledge and belief. In case this claim is determined by the Bank to be false or maliciously made, I shall be fully responsible for the consequences which may include civil/criminal lawsuit being initiated by the Bank.