When disputes occur between a customer and a bank, it is important for both parties to document the issue in writing. This form, provided by Cimb Bank, can be filled out to provide a clear account of the disagreement. The information included in this declaration will help Cimb Bank investigate the situation and work towards a resolution. Details such as date, time, and contact information should be included so that the bank can reach out to the customer if necessary. Any relevant supporting documentation can also be attached to help illustrate the situation. By completing this form, both customers and banks can have a record of what happened and what was said during the dispute. This can be helpful if legal action needs to be taken or if either party wants to pursue mediation.
| Question | Answer |
|---|---|
| Form Name | Cimb Bank Dispute Declaration Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | cimb form download, dispute form cimb, cimb bank declaration, dispute declaration form |
Strictly Private and Confidential
To: The Officer in Charge
Credit Cards & Personal Financing (ECO)
Robinson Road
P. O. Box 0088
Singapore 900138
Cardholder Name: |
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Credit Card No.: |
– |
– |
DISPUTE DECLARATION FORM
Customer Hotline Number: +65 6333 6666
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No. |
Merchant Name |
Transaction Date |
Amount (SGD) |
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1.
2.
3.
4.
5.
Please tick ✓ one category that best describe your reason for disputing the transaction(s).
I did not authorize or participate in the above transaction(s) and the card was in my possession at time of the said transaction(s).
I did authorize and participate in the transaction for SGD |
at |
(merchant) but |
did not participate in the other transactions(s) and my card was in my possession at time of the other transactions(s). |
|
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I had only authorized one transaction. The above transactions(s) is/are duplicate(s)
I have notified the merchant to cancel the recurring membership/subscription on |
(date). Enclosed is the merchant |
acknowledgement on the cancellation. |
|
The same transaction(s) was/were paid by other means. Enclosed is my proof of payment.
I have cancelled the hotel reservation. Enclosed is the hotel’s cancellation confirmation.
I have not received the merchandise and the expected date of delivery was |
. Enclosed is the confirmation stating the |
expected date of delivery. |
|
I would like to request a copy of the sales draft for own reference and understand a retrieval fee of SGD$5.00 is applicable.
My Credit Card was lost/stolen on |
(date) and at |
(time). Enclosed is the police report for reference. |
Others (Please provide additional information)
I hereby confirm that the above informations are true and accurate. I acknowledge and agree that I am bound by the terms and conditions of CIMB Bank’s Cardmember’s agreement. I agree to bear the retrieval fee of S$5.00 each if transactions are found to be genuine.
Signature of Cardholder
Name as per NRIC/Passport:
NRIC/Passport No.:
Contact No.:
Date:
Note: Please return the completed form to us within 14 days from the statement date of the disputed transaction.
Thank you for banking with CIMB Bank. |
CIMB Bank Berhad |
V2020 APR |
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