Digital Banking Dispute Form

Important Instructions for Customers:

• Call phone banking on 18002586161 to block UPI/ Net Banking / Credit Card /Aadhaar Enabled transactions
• Inform branch staff to mark a no-debit in your account to prevent any further transactions.
• For Payzapp related disputes call on 1800 102 9426 or email at [email protected]
• Call National Cyber Crime Helpline number on 1930 or Online reporting portal by logging to “https://www.cybercrime.gov.in
to report the incident. Mention the complaint / reference number on the form.

Customer’s Name Ranjit Kumar Nayak

______________________________________________________________________
Customer ID 43688268
_________________________

Credit/Debit/Prepaid Card Number: 4 6 3 9 1 7 X X X X X X 2 0 9 2

Account Number:

UPI ID:

Aadhaar Number (only last 4 digits) X X X X X X X X 3 7 7 0

Dispute pertaining to: UPI Credit Card Debit Card Prepaid Card Aadhaar Enabled Transactions
Net Banking/Mobile Banking

DETAILS OF DISPUTED ITEM(S):

TRANSACTION DATE TRANSACTION DESCRIPTION MERCHANT DETAILS TRANSACTION AMOUNT

22-February-2024 AMAZONRECHAG AMAZONRECHAG 1000.00

22-February-2024 AMAZONRECHAG AMAZONRECHAG 3000.00
22-February-2024 AMAZONRECHAG AMAZONRECHAG 2000.00
22-February-2024 AMAZONRECHAG AMAZONRECHAG 3000.00
22-February-2024 AMAZONRECHAG AMAZONRECHAG 4000.00 <-(Intimation yet to received)

Mandatory Section

❑ I authorise the Bank to mark a no debit in the above-mentioned account.

❑ I do not authorise the Bank to mark a no debit in the above-mentioned account for the below reasons
__________________________________________________________________________________________

(Kindly note that in case card/account is not blocked, the liability for current and future transactions remains with the customer and not
with the Bank)
❑ I have called National Cyber Crime Helpline number on 1930/ logged on to https://www.cybercrime.gov.in to report the incident.
Please find the complaint/reference No_____________________________________________

Brief description of how the transaction has taken place:

* Mandatory Fields Classification - Internal
I received an SMS this morning saying that 5 transactions were done, but they were not done by me. The first transaction was

done at 7:08 AM to 9:18 AM and the total amount was 13,000 for 5 transactions. I noticed this at 930 AM.

There were confirmation amount spent for these 5 transaction and sms for OTP as well, this I m enclosing herewith.

To be filled in case of Debit/Credit/Prepaid Card related Disputes

❑ I have neither authorized nor participated in the above transaction(s). I confirm that the card is still in my possession.

❑ My card was lost/stolen on ______________ and the same was reported to you on ______________. (Attach copy of Police
complaint, mandatory for disputes)

❑ Duplicate/Multiple billing. I have done only __ transaction(s) at the Merchant Establishment but I was billed ____ times. (Attach
copy of authorized charge slip)

❑ I have cancelled the transaction(s)/returned the goods, but have not received credit/refund for the same (Attach Credit
Voucher/Refund note/Merchant’s letter or any form of merchant’s confirmation that the credit is due to the card account)

❑ The service / merchandise that I have received are not as described or found defective (Attach copy of all correspondence had
with the merchant, proof that goods were returned to the merchant OR proof of merchant acknowledging the cancellation
intimation)

❑ The transaction was Unsuccessful OR the Merchant confirms non-receipt of payment (Provide clear description of the goods or
services ordered / copy of all correspondence with the merchant)
❑ I ordered goods/services and the same were expected to be delivered by date (dd/mm/yy) ___________, but I never received the
same. (Attach order confirmation / Provide clear description of the goods or services ordered / copy of all correspondence had
with the merchant)

❑ Paid by alternate means. I gave my card for payment, but later on paid by other means for the same transaction. I Paid by Cash
(attach cash receipt/bill)/ Cheque (attach Cheque /Bank statement)/ Other card (attach chargeslip/other card statement)
❑ Cancelled Membership/Subscription/Booking. (Attach proof of cancellation)
❑ The transaction amount incurred/authorized by me is for Rs. ___________ but I was billed for Rs. __________. (Attach copy of
authorized charge slip / Invoice copy)

❑ Cash was not dispensed at the ATM but I was billed for the entire amount of Rs. _____________.
❑ Cash was dispensed partially in the ATM for Rs. ___________ but I was billed for the entire amount of Rs. __________.

❑ Others (Please explain in detail. Please attach a separate letter if necessary)

* Mandatory Fields Classification - Internal

To be filled in case of Aadhaar Enabled Transaction dispute:(All questions mandatory)
❑ I have neither authorised nor participated in the above transaction(s). I authorise bank to delink Aadhaar number and disable
Aadhaar based payment transactions. Yes No
❑ Aadhaar Number updated for Direct Benefit Transfer (DBT): Yes No
❑ Is there any Joint holder in customer’s account: Yes No
❑ If yes, then is Joint holder aware of this fraudulent transaction reported by other account holder: - Yes No
❑ Has customer shared his/ her biometric with other entity/person for any purpose since the last 6 months? Yes No
If yes, provide details.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
❑ Does customer regularly carry out AePS transactions at same Business Correspondent locations? Yes No
❑ How did the customer come to know about the fraudulent transaction in his/her
account?_______________________________________________________________________________________________
______________________________________________________________________________________________________
❑ Customer’s Location at the time of Transaction?
_________________________________________________________________________
❑ Is customer’s Mobile Number/Email Id updated in Aadhaar card? Yes No
❑ Is customer’s currently used Aadhaar Number updated in Bank’s system for SMS alerts? Yes No
Also was the same number user by the customer at the time of disputed transaction? Yes No
❑ Reason for late reporting of Fraudulent transactions by customer (applicable for fraudulent transactions reporting done after
3 months from the date of transaction)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

I declare that above given information is true and correct to my knowledge. I understand that I can be held liable for all charges
incurred if dispute raised by me is found invalid. The Bank may contact me whenever it requires any further information.
[email protected] 9040018988
Email ID* : ______________ Mobile No* :____________________

Signature*: _____________________ 22-February-2024

Date & Time (AM/PM): _____________________

Important Note:
❖ For authorized transactions, an attempt to resolve the dispute with the merchant must be made first before we can take action
on your claim.
❖ Please ensure to provide appropriate documentation as indicated against the dispute reason which would enable us to make
every possible effort to assist in resolving your dispute.
❖ Customer can file a police complaint by following below mentioned options: -
➢ Report the incident to National Cyber Crime Helpline Number at 1930 or 155260
➢ Report through online portal at https://cybercrime.gov.in/Webform/Crime_AuthoLogin.aspx /
http://www.cybercrime.gov.in/"www.cybercrime.gov.in )
❖ Online complaint is followed by serial number, hence same is accepted. Physical copy needs to have seal and signature of
police official.
❖ CDF is a mandatory document to be submitted for all transaction disputes.
❖ Copy of Police complaint is mandatory to be submitted for all disputes where the transaction amount is greater than Rs. 50000/-
and in case of Aadhaar + Biometric fraud FIR is mandatory for amount greater than or equal to 10,000.
❖ Please send the duly filled CDF from your registered email ID to
❖ For all Card disputes ❖ [email protected]
❖ For Net Banking / Mobile Banking unauthorised transactions ❖ [email protected]

* Mandatory Fields Classification - Internal