ATTN:

Globe Fintech Innovations, Inc.

G-Xchange, Inc.

To whom it may concern:

I am a GCash subscriber and I am registered to the GCash service. I would like to file a formal complaint
against ____________________________ with the mobile number __________________ and
address at ________________________________________________________ because he/she has
defrauded me in the amount of P______________________________ which is the amount of GCash
I sent to him/her on _________________________________ under the following circumstances:

(State the Reason for Sending GCash)

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

I would like to request that the GCash Wallet of said Mobile Phone Number be blocked to prevent the
transfer/cash-out of the GCash I have sent.

I hereby undertake to submit within forty-eight (48) hours from today a notarized copy of this
Complaint-Affidavit/Form filed against __________________________________. You may unblock
the said GCash Wallet if I fail to submit the Notarized Complaint Affidavit/Form within the 48-hr
period.

I hereby state under oath that all my statements herein are true and correct. I shall render Mynt/G-
Xchange Inc./Globe Fintech Innovations Inc. free and harmless from all claims and suits which may be
filed by ___________________________________ or by any person or entity arising from the blocking
of the GCash Wallet of Mobile Phone No. _______________________ or in connection with any action
that may be taken by Mynt/G-Xchange Inc./Globe Fintech Innovations, Inc. as a result of my formal
complaint.

Name of Complainant:_______________________________________________________________
Address:___________________________________________________________________________
Contact Nos.:____________________________________
Email Address:___________________________________
Transaction Date and Time:_________________________
GCash Reference No.:_____________________________
Acknowledgement Receipt No.:______________________
GCash Service Form No.:___________________________
Official Receipt No.________________________________

30th Street corner

9th Avenue, BGC,
The Fort, Taguig City
____________________
Signature of Complainant

www.GCash.com
Hello@GCash.com
GCashOfficial
2882

Subscribed and sworn to before me this ____ day of ________________, 20____ in

____________________________, affiant exhibiting to me his/her Community Tax Certificate No.

___________________ issued on ________________ in __________________.

No
tary Public

Doc. No. __________

Book No. __________

Page No. __________

Series of __________

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*Submit fully accomplished and notarized form to MYNT GCASH FRAUD TEAM G-Xchange, Inc. |
Mynt 8/F W Global Center, 9th Ave. 30 st. Bonifacio High Street Bonifacio Global City, Taguig 1634
th