Axis Bank Customer Dispute Form 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.

QuestionAnswer
Form NameAxis Bank Dispute Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesccrs form axis bank, axis bank card dispute form, customer dispute form axis bank, where to submit axis bank dispute form

Form Preview Example

C ha rg e Dispute Fo rm

Kind ly ta ke a p rint o f this fo rm a nd fill it c o m p le te ly if yo u a re d isp uting a tra nsa c tio n p o ste d to yo ur c re d it c a rd a c c o unt. Yo ur d uly fille d a nd sig ne d fo rm (se c tio ns A-C ) m ust re a c h us e ithe r via m a il, fa x o r e -m a il (Sc a nne d c o p y) w ithin 30 d a ys o f yo ur sta te m e nt d a te a lo ng w ith a ll the sup p o rting d o c um e nta tio n (The

re le va nt

sta te m e nt c o p y d uly m a rking the d isp ute d a m o unt(s) / c ha rg e slip / c o rre sp o nd e nc e / c a sh

re c e ip t /

p o sta l re c e ip ts e tc .).

Afte r the la p se o f 30 d a ys fro m yo ur sta te m e nt d a te , it w ill b e c o nstrue d tha t a ll tra nsa c tio ns p o ste d in the sta te m e nt a re a c c e p ta b le a nd a re in o rd e r.

Se c tio n A - G e ne ra l Info rm a tio n:

Ple a se pro vide a ll o f the fo llo wing info rm a tio n a nd sig n the fo rm whe re indic a te d:

(If the c ha rg e und e r d isp ute is inc urre d o n the a d d -o n c a rd ho ld e r c a rd , the n the d e c la ra tio n ne e d s to b e fille d b y the a d d -o n c a rd ho ld e r)

C re dit C a rd Num b e r:

Se c tio n B – Tra nsa c tio n Info rm a tio n:

Ple a se pro vide a ll o f the fo llo wing info rm a tio n re g a rding the tra nsa c tio n(s) b e ing dispute d:

Sr. No

Tra nsa c tio n Da te

Me rc ha nt Na m e / ATM Lo c a tio n

Tra nsa c tio n Am o unt

Disp ute d Am o unt

Se c tio n C – Dispute Type :

Re a d e a c h o f the fo llo wing de sc riptio ns c a re fully a nd c he c k the o ne b o x (1- 11) tha t m o st a ppro pria te ly fits yo ur pa rtic ula r dispute :

The c ha rg e ha s no t b e e n inc urre d b y m e a nd the c a rd w a s in m y p o sse ssio n a t the tim e o f tra nsa c tio n.

I ha ve b e e n

b ille d the

w ro ng a m o unt. Enc lo se d is a c o p y o f m y c ha rg e slip sho w ing

the a m o unt

 

___________a utho rize d b y m e .

 

 

 

 

 

 

 

 

 

I ha ve no t inc urre d the a b o ve c ha rg e (s) b ut inc urre d a c ha rg e o f Rs.

 

 

o n d t

 

 

a t the

 

 

 

 

 

 

 

 

 

 

sa m e m e rc ha nt o utle t (e nc lo se d c ha rg e slip ). My c a rd w a s in m y p o sse ssio n a t a ll tim e s.

 

 

 

I ha ve b e e n b ille d m o re tha n o nc e fo r the sa m e tra nsa c tio n. I a utho rize o nly o ne c ha rg e w ith this

 

 

m e rc ha nt fo r the a m o unt o f _________ o n _____/ _____/ _____.

 

 

 

 

 

 

 

I ha ve se ttle d this c ha rg e d ire c tly w ith the Esta b lishm e nt b y o the r m e a ns (Enc lo se c o p y o f re c e ip t issue d

 

b y the Esta b lishm e nt, e vid e nc ing d ire c t se ttle m e nt. If the p a ym e nt to

the m e rc ha nt is m a d e thro ug h

 

c he q ue , p ro vid e b a nk sta te m e nt c o p y sho w ing

the d e b it. If the p a ym e nt is m a d e

thro ug h a ny o the r

 

c a rd , p le a se

p ro vid e the

sta te m e nt sho w ing the

d e b it. If c a sh p a ym e nt is m a d e , p le a se

p ro vid e

c a sh

 

re c e ip t).

 

 

 

 

 

 

 

 

 

 

 

My a c c o unt

ha s b e e n

c ha rg e d fo r the tra nsa c tio n liste d a b o ve ,

b ut I ha ve

no t

re c e ive d

the

 

m e rc ha nd ise o r se rvic e . (Enc lo se is the c o p y o f c o rre sp o nd e nc e w ith m e rc ha nt)

 

 

 

 

Page 1 of 1

The item purchased do not conform to what was agreed by the merchant or was defective. (Please specify as to what goods or services 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 have cancelled the subscription / membership / policy (circle one) on ____/____/____ (Please provide

proof of cancellation) yet the charge is billed to my credit card.

I have not withdrawn cash from ATM.

Cash not dispensed at __________________ ATM or partial cash dispensed Rs. (or local currency)

__________only.

I have received a refund slip from the merchant; however the charges are still billed to my card account. (Enclose the refund slip)

Ihave not incurred or authorized the charge.

I have cancelled the hotel reservation under cancellation code ________ date of cancellation ___/__/___

I have not made any Hotel reservations.

If none of the above reasons apply: Please print this form and provide a complete description of the dispute along with your attempted resolution with the merchant. Also enclose any documentation that may support your claim.

Please Note:

On receipt of the dispute claim along with the relevant supporting documentation, we will raise the dispute with the member bank and request them to provide the details on the basis of which the disputed charge was processed to your card account. On clarification from member bank regarding the disputed charge we shall revert to you with clarifications on the dispute, which normally takes 90 to 120 days of time in accordance with VISA dispute resolution rules.

I hereby affirm that the information furnished above is true to the best of my knowledge.

__________________________

__ ______

Signature

Date

The form should be sent to us with the relevant supporting documents by fax/ e-mail/ courier to:

Card Customer Service - Billing Disputes

Axis Bank Ltd,

Solaris Tower ‘C’, 6th Floor,

Opp.L&T Gate No 6, Saki Vihar Road,

Powai, Mumbai - 400072

Fax 022-40754632

Email Id: Customer.services@axisbank.com

Contact No: 1800 233 5577 or 1800 209 5577 or 1800 103 5577

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