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Cardholder Transaction Dispute Form

The document is a Cardholder Dispute Form submitted by Shahzad Aslam Awan to dispute a transaction of 114.99 AED dated 21/12/2025 at Sag Pay, which he claims is unauthorized and not recognized. He requests clarification on the transaction details and indicates that his card was in his possession at the time of the transaction. The form includes a declaration affirming the truthfulness of the information provided and instructions for submitting the completed form via email.

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josinalien
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30 views1 page

Cardholder Transaction Dispute Form

The document is a Cardholder Dispute Form submitted by Shahzad Aslam Awan to dispute a transaction of 114.99 AED dated 21/12/2025 at Sag Pay, which he claims is unauthorized and not recognized. He requests clarification on the transaction details and indicates that his card was in his possession at the time of the transaction. The form includes a declaration affirming the truthfulness of the information provided and instructions for submitting the completed form via email.

Uploaded by

josinalien
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

CARDHOLDER DISPUTE FORM

Card Number
4 0 8 5 6 5 8 9 2 5 7 1 3 0 5 4

Details of disputed transaction(s) shown in my statement dated


2 1 M
D D 1 2
M 2
Y 5
Y

S. No. Transaction Date (s) Name of Merchant Transaction Amount

1. 21/12/2025 Sag pay 114.99


2.

3.

4.

I have examined the changes made to my card account and wish to dispute the aforementioned transaction/s for the
following reason:
AB486597887
Transaction No. not recognized. Need more clarification on the following details:
Merchant Name Sag pay Merchant Location
Don't know
Transaction date(s) 21 Transaction amount
AB486597887
114.99
Unauthorize or Not participated in the transaction No.
AB486597887
Aed
Transaction No. Incomplete / Failed / Not authorized. Attached transaction slip (Yes / No)
AB486597887
Transaction No. has been Duplicated, only one sale was authorized.

Incurred one transaction dated at the above mentioned merchant establishment and not incurred the
AB486597887
transaction(s) No. listed above. Attached a copy of accepted transaction (Yes/ No)
AB486597887
Transaction No. amount incurred was but billed for
Attached a copy of the transaction slip for genuine transaction (Yes/ No)

Service / Goods relates to Transaction No. not received. Expected date of receipt DD / MM / YYYY
Attached a copy of the letter to merchant attempting to resolve the dispute.

Credit voucher for the transaction No. was issued on but not processed to the card account.
Attached a copy of credit refund slip / cancellation letter from the merchant establishment.
AB486597887
Transaction No. Cancelled recurring Membership / Subscription. Date of Cancellation DD / MM / YYYY
AB486597887
Transaction No. , Hotel reservation cancelled on but billed for “no show” charge. The
cancellation number is
AB486597887
Transaction No. , Paid the amount by other means, evidence of payment by Cash / Cheque / Credit card /
Others is attached.

Other Dispute Reasons: It's isn't my trasacitocn AB486597887 i want my money back

DECLARATION

I hereby affirm that the information furnished above is true to the best of my knowledge.
My card was in my position and control at the time of the questioned transaction.
Name Shahzad aslam awan Contact Number +971555209879

2 1 M
D D 1 2
M 2
Y 5
Y

Kindly e-mail back the completed dispute form from your registered e-mail ID to Dispute@[Link]

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