‫ﺳﺎﻟﻚ‬

‫اﺳﺘﻤﺎرة اﻟﺪﻋﻢ اﻟﻤﺎﻟﻲ‬ Salik

Customer financial support form

‫ﺑﻄﺎﻗﺔ ﺗﻌﺒﺌﺔ ﺗﺎﻟﻔﺔ‬

Damaged Recharge Card Customer Name / ‫اﺳﻢ اﻟﻤﺘﻌﺎﻣﻞ‬

‫ﺷﻜﻮى ﻋﻦ اﻟﺪﻓﻊ اﻹﻟﻜﺘﺮوﻧﻲ‬

Online Payment Dispute Account Number / ‫رﻗﻢ اﻟﺤﺴﺎب‬

‫ﻃﻠﺐ ﺗﺤﻮﻳﻞ رﺻﻴﺪ‬

Recharge Transfer Callback Number / ‫رﻗﻢ اﻟﺘﻮاﺻﻞ‬

E-mail / ‫اﻟﺒﺮﻳﺪ اﻻﻟﻜﺘﺮوﻧﻲ‬

Transaction Date / ‫ﺗﺎرﻳﺦ اﻟﺘﻌﺒﺌﺔ‬ Amount Paid / ‫اﻟﻤﺒﻠﻎ اﻟﻤﺪﻓﻮع‬

In case of damaged recharge card / ‫ﻓﻲ ﺣﺎﻟﺔ ﺑﻄﺎﻗﺔ ﺗﻌﺒﺌﺔ ﺗﺎﻟﻔﺔ‬

Sequence Number / ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ ﻟﻠﺒﻄﺎﻗﺔ‬

In case of Online Payment Dispute / ‫ﻓﻲ ﺣﺎﻟﺔ ﺷﻜﻮى ﻋﻦ اﻟﺪﻓﻊ اﻹﻟﻜﺘﺮوﻧﻲ‬

Amount / ‫اﻟﻤﺒﻠﻎ‬ Transaction Number / ‫رﻗﻢ اﻟﻤﻌﺎﻣﻠﺔ‬

Recharge channel / ‫ﻗﻨﺎة ﺗﻌﺒﺌﺔ اﻟﺮﺻﻴﺪ‬

‫ﻓﻲ ﺣﺎﻟﺔ ﻃﻠﺐ ﺗﺤﻮﻳﻞ رﺻﻴﺪ ﻳﺮﺟﻰ إدﺧﺎل ﺑﻴﺎﻧﺎت اﻟﺤﺴﺎب اﻟﻤﺮاد ﺗﺤﻮﻳﻞ اﻟﺮﺻﻴﺪ إﻟﻴﻪ‬
In case of Recharge Transfer please enter the account details to which the balance will be transferred to

Account Number / ‫رﻗﻢ اﻟﺤﺴﺎب‬ Customer Name / ‫اﺳﻢ اﻟﻤﺘﻌﺎﻣﻞ‬

Relationship with the customer / ‫اﻟﻌﻼﻗﺔ ﻣﻊ اﻟﻤﺘﻌﺎﻣﻞ‬

Comments / ‫ﻣﻼﺣﻈﺎت‬

Date / ‫اﻟﺘﺎرﻳﺦ‬ Signature / ‫اﻟﺘﻮﻗﻴﻊ‬

Location / ‫اﻟﻤﺮﻛﺰ‬