CARDHOLDER’S STATEMENT OF DISPUTED ITEM, Date 1 NOVEMBER 26, 20/9 Cardholder's Name MaRqil CHLOYD LEE ‘Compromised Card Number SH5E [229 O87) 8945. — Posting Date “Transaction Date Merchant Name Billing Amount NOVEMBER 20,2019 | Novernngr (2 2017 | AIRBNE /58005%09 8 | = 21,152. /@ AovePne® 20,2019 |NovemBER (82017 | ARBuB 14/58005959 68 | 21, 254. Hef NOVEMBER 25,2017 | NOVEMBER 28201; RNs 14158005759 6 | 4B,c00. 05. have examined the transaction(s) above and dispute the item(s) based on the following reasons (Please check one) 77 | certify that neither I nor anyone authorized by me participated in the above transaction(s) and that my card is in my possession at all times. [7 Lenzaeed in one transaction from the same merchant location, however, I was charged for more than one ‘transaction that neither I nor anyone else authorized. I certify that my card was in my possession atthe ti of the transaction. (REQUIREMENT: SALES SLIP OF THE VALID TRANSACTION) Others please specify REMARKS: | hereby declare that all information indicated above is true and that my dispute will only be processed upon completion ofthis form. 5 ‘SIGNATURE: (Owner of the card w Note: + Please send the accomplished dispute form to bpidispute@bpicom.p. You may also fllow up by calling 580.0496, + Ifcardholder continues to dispute the transaction but transaction was subsequently proven tobe valid transaetion amount plus the fees and other charges incurred by BPI asa result will be charged to the cardholder. + Reported disputes ean be accommadated within thiny (3) calendar days from the statement date indicated inthe SOA