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Date Merchant Name: Reason For Adjustment

This document is a merchant request form for a debit transaction adjustment from BDO Bank. It contains fields for the merchant to provide their name and address, transaction details including the amounts, date and time, card details, and a reason for the requested adjustment such as an overcharge, incorrect amount, or returned item. The merchant signs to authorize BDO to deduct the adjustment amount from their account.

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Dada Baraniano Pandaan
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309 views1 page

Date Merchant Name: Reason For Adjustment

This document is a merchant request form for a debit transaction adjustment from BDO Bank. It contains fields for the merchant to provide their name and address, transaction details including the amounts, date and time, card details, and a reason for the requested adjustment such as an overcharge, incorrect amount, or returned item. The merchant signs to authorize BDO to deduct the adjustment amount from their account.

Uploaded by

Dada Baraniano Pandaan
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
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MERCHANT REQUEST FOR ADJUSTMENT

For PIN-Based Debit Transactions

Date

Merchant Name

Merchant Address

Contact Number Debit Terminal Number

This will authorize BDO to deduct the amount indicated below from my Debit/Credit* settlement transactions or from any
BDO Debit account proceeds:

* Applicable to Merchants with Credit Card Transactions

Transaction Details

Amount for Reversal (Amount to be returned to the cardholder) Php

Transacted Amount (Amount transacted on the POS terminal) Php

Correct Amount (Actual amount of item/service) Php

Transaction Date

Time

Cardholder’s Name (Optional)

Card Number

Receipt Number (POS IST Activity Report / Trace or Invoice on the Charge Slip)

Reason for Adjustment

 Multiple Debit  Used other Card  Transacted on other POS Terminal

 Overcharged  Returned Item/Service  Incorrect Transacted Amount

 Paid in Cash  POS Terminal Error  POS No Receipt Generated

Notes:
• Only completely filled out Transaction Details with selected Reason for Adjustment will be processed.
• Any erasures/changes must be counter signed by the Authorized Signatory. Please refer to your Secretary’s Certificate
for the list of your Authorized Signatories.
• Please email fully-accomplished form to the BDO Merchant Services Unit at [email protected]. or fax at

Authorized Signatory Designation / Position


Signature Over Printed Name / Date
For concerns or inquiries, contact BDO Merchant Services at (02) 8702-6900 (PLDT) | (02) 7909-6900 (GLOBE) or email [email protected].
BDO Unibank Inc. is regulated by Bangko Sentral ng Pilipinas: Tel No. (02) 8-708-7087; Email: [email protected]
The BDO, BDO Unibank, and other BDO-related trademarks are owned by BDO Unibank, Inc. REVISED: APRIL 2021

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