REQUEST FOR CANCELLATION / REFUND OF ONLINE TRANSACTION (v2.4.

3)

Please provide the details of the transaction that you wish to request for refund and revert it to us by:
Scan and email to us at sg.refund@wirecard.com (form MUST be endorsed by signature and company stamp)
Please allow 5 business days for the processing of refunds.

1. MERCHANT DETAILS
Name of Merchant

Merchant ID (LIVE)

Contact Person Contact Tel:

Email Address

2. TRANSACTION DETAILS

VISA MASTER JCB CUP AMEX DINERS

Transaction Type
EPP eNETS DEBIT OTHER _________

Transaction Date (DD/MM/YYYY format)

Transaction Reference /
Credit Card No (Truncated)
e.g. 123456 xxxxxxx 7890 (first 6 & last Approval Code
4 digits of card no)
**Failure to complete as above, will
cause this form to be rejected**

Transaction Amount Cancel Existing EPP Yes No

Amount to Refund FULL Refund PARTIAL Refund

Description of Purchase
Reason for Refund /
Cancellation
3. CUSTOMER BANK ACCOUNT DETAILS ( FOR eNETS DEBIT ONLY)
Please provide the information below as all eNETS refunds will be via GIRO to customer
Name of Customer
(as per Bank records)
Mailing Address

Contact Number

Bank Name Branch Code Account No.

4. AUTHORISED SIGNATORY & COMPANY STAMP

Name of Signatory:

Designation of Signatory:

Signature & Company Stamp Date of Request:

5. FOR Wirecard USE ONLY

Transaction ID: Transaction ID:

Approval Code: Date of Submission to Bank:

Remarks:

Should you have any query, please contact us for further assistance:
Email: sg.refund@wirecard.com
Tel: 6643 5998 (SG) / 800 961 978 (HK) / 1 800 806 858 (MY) / 1 800 1651 0820 (PH)

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