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Date: ___ CARDHOLDER TRANSACTION DISPUTE FORM (#42 A BAA SORPUAS oH ¢ DBS Hank (Vong Kong) Limited (the Wavke") BER: (RH) ARAL ARE) CCutdholdcrs Name FEE AEG Cad Number (SM=BK Transaeton Date 7 Disputed Traction Anant ae ‘Merchant Name #40) ae 1AM DISPUTING TILE ABOVE CHARGE(S) BECAUSE: AREOLA M2 IROGEE¢ (Please tek either Part I OR Part H whichever ix upplicable AA RIAESAEAGA | RPI 2 3865 Pas ch 1) thave cancetied the reeuring transaction(s) with 1a il being cha ped. 6 CERUAIURE FARMERS oe + le Merchant {oupporting docuventaltched). However, eR CHL SC «A C1 Nowscccipt of goods 7 servives. The scheduled date of gnods / services delivery was on (oupporting document aac. | ve alteped to resolve the dpe with the Merchant guider aa the flowing canna! but fuibed. FARIA # AURA UL ALS BU) BRR) « AE SAI MERGERS TIS SLA US RAMP Tat + Diutostine sears = C)emait erst: [others at (1 Aealy authorized the transection amoual of ‘und have never agreed the Merchint to harge me ut Hong Kong Dollar (supporting dowunvent tached). A SA2HE ROS Ba 5B ARATE AE! SENTRA GL LAE ZEAE 1 the tranuction(s) vaswere paid hy other means as shown in de attached document, ie. ey ofthe respective recip ingoice or statement. SRSA A=URICH FRIED: AONE » BERLE RIE) ne iny the eke wanstions) fr aid was in ry. possesion atte tne of the otter tassios). 25 ARIA gD (UES) 2 WA ea NES, WH TA MAA ST (1 ony eter int ne tant fr S (oes patched) an i et 5 SK E+ [1 he tes mount wae dierent from the salen sip dat thave astorsed (ales slip attached). EAL SEM 26, RAT ASG) + (1 Reimbursentent not processed - I envlose my copy’ of Credit Refund slip as the funds have wot been ereditsd to may card seeount yet A Ara SRR ORM LAIR Leertiy at Hhave attempted to resolve the dispute with the Mecchant but falled. 7RAESBRSUTURONY «LSM MDRA a Pe SE 2 (7) 1ait not matorizo nor enter int the ranasetion(s). A RERPS FFM RUE ICM 1 authorize and age the Bank to ferninate the shove eredit card with innnediat fect. wil contact the Bank separately to arrange a replacement card in case there is @ need. [a care I do uot request the Bank to replace this eard within 3 mouths, I gree the Bank to terminate my enrd account without further wots. ARIK IRE RE SUCTIOEGRE ELE TOT » SOR» ‘Agpiarrsinniane esha 3 (PUD AR FOREPTORAARBRRT ACAI OTHER IRI PRCA A te Ay other reas or ems: FERLIATRGRIRE: (Please use ner sheet f mcessny. SUR FDR «| "Before you provide the Bank wih your personal details leave envive hat you have read and understood the Banks Data Policy. By providing personat details ote Hank ander this form, sou shall be deemed ta have accepted the Bank's Data Policy and agreed t ‘the use of sour personal detlls as stared therein. SRE PSTT#URER BIOSEATOTEUIVFLRE* 4 WACFTSDROISAOA 3287 S065 UM AERO VLA BIE" RE OORT RT TIPE ER PIS BE PT REINA BRTALEE « ‘CARDHOLDER’S SIGNATURE & DATE #-RABH ROM Note: Please return tis fon withthe suppavting doeunen) to our hank by fx or by mail within 1 calendar days FORE RATS NL AAN AHMAR HENLE ALT + [DNS Bask (Nong Kong) init (RO No 29 Nang Kang Fav A: 862.2808 5225 HAO RSMARES GOS RRR BAAMAA (2 March 5)