Axis Bank Dispute Form PDF Details

The Axis bank dispute form is an online document that can be completed to file a complaint against the bank. It will allow customers to make a formal request for investigations into the banking activity of the company. The information gathered by this form can lead to disciplinary action or criminal penalties depending on how severe the case may be. The Axis bank dispute form requires all relevant details about what happened during your last interaction with the company, including what you discussed and any agreements that were made. This includes how much money was taken from your account, why it was taken, if there are other documents which could help prove your side of things and more detail about what happened in general.

Below is some information that may be helpful if you're aiming to find out just how long it'll take you to complete axis bank dispute form and what number of PDF pages it contains.

Form NameAxis Bank Dispute Form
Form Length1 pages
Fillable fields61
Avg. time to fill out12 min 31 sec
Other namesccrs form axis bank, axis bank upi transaction dispute, axis bank customer dispute form, customer dispute form axis bank

Form Preview Example

Cardholder Dispute Form


Axis Bank Ltd, NPC1, 5th Floor, "Gigaplex", Plot No I.T.5,

MIDC, Airoli Knowledge Park, Airoli, Navi Mumbai - 400708.

Fax no - 022 71315270

Axis Bank Customer

Cardholder’s Name Contact Number Email

Debit/Credit/Forex Card number** Axis Bank Account Number

(Applicable For Debit Cardholders only)

Yes No


Details of Disputed Transaction/s



Transaction Date

Merchant Name/ATM Location

Transaction Amount & Currency

Disputed Amount & Currency













































































































I am disputing transaction/s listed above due to the following reasons. Request you to resolve the dispute.

Kindly () the issue as per applicable

Duplicate/multiple billing. I have done only one transaction but I was billed ______________ (Twice/Thrice etc).

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. (Please specify as to what good/s or service/s were expected and what were actually delivered. Enclose any documentation that supports your claim. If you have returned the merchandise to the merchant, please provide us with 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 of ______________ (provide Amount & Currency) dispensed in the ATM but I was billed for the entire amount ______________

(provide Amount & Currency).

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. First I gave my card for payment and later on I changed my mind and paid by other means like 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 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 ______________ (provide Amount & Currency) but I was billed for ______________ (provide Amount & Currency).

I have not participated or authorized the above transaction(s). The card was in my possession at all times. Hotel Reservation:

(A)I have cancelled the Reservation. 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. Please attach a separate letter if necessary) _____________________________________

**Request to the Cardholder: Please attach copies of your correspondence with the Merchant, charge-slips wherever applicable and any supplementary documents pertaining to the transaction/s, as appropriate.


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.



Place ___________________________________________

Customer Signature

How to Edit Axis Bank Dispute Form Online for Free

Our top level software engineers have worked together to design the PDF editor which you can begin using. This particular software enables you to prepare axis bank charge dispute form online forms shortly and effortlessly. This is all you have to do.

Step 1: Search for the button "Get Form Here" and press it.

Step 2: Now, you're on the form editing page. You can add content, edit existing details, highlight specific words or phrases, insert crosses or checks, add images, sign the document, erase unnecessary fields, etc.

These particular areas will frame the PDF form that you will be creating:

step 1 to writing ccrs form axis bank

Write the necessary data in the Duplicate, multiple billing segment.

ccrs form axis bank Duplicate/multiple billing fields to fill

You need to emphasize the significant particulars within the Others (Please explain in detail, **Request to the Card, holder I hereby con, rm that the aver, ment, s Declaration, Date D D M M Y Y Y Y, Place , and Customer Signature area.

Completing ccrs form axis bank part 3

Step 3: Hit the Done button to be sure that your finalized document can be transferred to any kind of gadget you end up picking or sent to an email you indicate.

Step 4: To prevent any sort of hassles in the future, be sure to have a minimum of a few duplicates of the document.

Watch Axis Bank Dispute Form Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .