Payment Reversal Request Form

This form consists of the following parts:

Part A: Instructions
Part B: Conditions
Part C: Payment reversal request details
Part D: Indemnity and waiver

Instructions

1. This form must be completed in full and signed by the 4. If you have not received a reference number within 15 (fifteen)
accountholder/mandated representative. minutes, kindly check your spam mailbox. Alternatively, you may
contact the bank on the number at the bank of your card for
2. The completed form must be emailed to further assistance.
fnbdigitalrecalls@fnb.co.za.
3. You will receive an automated response with a reference number
for the reversal request.

Conditions

1. The Bank must obtain authority from the recipient before 11. If you have made a payment to an account listed below, please
reversing the payment from the recipient’s account. contact the respective department/service provider directly for
further assistance.
2. The balance available in the recipient’s account must be equal to
or exceed the amount paid/received.
- Public recipient accounts such as Edgars, SARS and
3. Reversals can only be attempted within 30 (thirty) calendar days Telkom etc.
from the date of payment. - Investment accounts such as 32-day notice accounts etc.
- Vehicle Finance accounts.
4. A partial reversal/recovery of funds is not possible. - Credit Card account.
5. A Reversal fee is charged at R325.50 (inclusive of VAT) per - Any loan account such as Home Loan, Personal Loan etc.
transaction, this fee is non-refundable. - eBucks Payments made to another eBucks account.

6. You will be charged a reversal fee irrespective of the result of the
reversal attempt.
7. There may be times where the Bank may not be able to affect a
reversal request. In such instances, the bank may, in good faith,
provide you with further details to assist you in approaching the
recipient directly to recover your funds. You must complete and
submit this form to fnbdigitalrecalls@fnb.co.za. Please note
that this request will be subject to a fee of R325.50 (inclusive
of VAT) per transaction.
8. Reversals will be attempted within 10 (ten) working days of the
bank receiving this form.
9. Feedback on the reversal attempt will be provided after 10 (ten)
working days from the bank receiving this form.
10. Payment Reversals are not possible for:
- Payments in excess of R5,000,000.00 (Five Million Rand)
- Payments using the Schedule Payments function.
- Payments using the Pay & Clear Now function.
12. The terms and conditions for electronic payments is applicable
and can be accessed on www.fnb.co.za, by selecting “Product
Terms and Conditions” under the “About FNB + Legal” tab.
13. Where you believe a fraudulent transaction has taken place, the
transaction must rather be reported to the bank’s fraud
department. To proceed with reporting the transaction with the
bank’s Fraud Department contact the bank immediately on
087 575 9444.
You will be required to submit the following
information/documentation to the bank’s Fraud Department:
- Account number of the complainant
- Suspected fraudulent account details
- SAPS case details
- An Affidavit
- Supporting documents (Proof of Payment)

In the above instances, the bank may, in good faith, provide you
with further details to assist you in approaching the recipient
directly to recover your funds. You must complete and submit
this form to fnbdigitalrecalls@fnb.co.za. Please note that this
request will be subject to a fee of R325.50 (inclusive of VAT)
per transaction.

A division of FirstRand Bank Limited. An Authorised Financial Services and Credit Provider (NCRCP20).
Payment Reversal Request Form
If this is a suspected Scam and/or Fraud related incident, URGENTLY contact the Fraud Line on 0875759444 for further
assistance. No fraud related matters can be handled through this reversal process / completion of this form
This form consists of the following parts:
Part A: Instructions Part C: Payment reversal request details
Part B: Conditions Part D: Indemnity and waiver

Select the below account where payments have been made to (only if applicable)

Public recipient accounts (such as municipalities, universities mobile operators etc.) Vehicle Finance accounts
eBucks payments made to another eBucks account Credit Card accounts
Investment accounts Any loan accounts
If you have made a payment into an account that is listed above, please contact the respective department/service provider
directly for further assistance.

Payment reversal request details

From Account
Acc No. Holder Name
Contact Contact
Name Number
Email
Address Date

Payer account details (i.e. Account to which the reversal charge shall be debited).

Account Account Branch

Holder Name Number Code

Beneficiary account details (i.e. Account details of the recipient).

If there is insufficient space below, please complete additional spreadsheet with all details.
Account Number Branch Code Bank Amount Transaction Date Reason for Reversal

Please select an option

Please select an option

Please select an option

Please note that payment reversals cannot be executed for erroneous Pay & Clear Now and/or Scheduled Payments.
Should you require the contact information of the recipient to recover your funds, the bank may assist you, however, Yes No
this is subject to the bank obtaining prior consent from the recipient to share their contact information with you.

Indemnity and Waiver

1. You indemnify and hold the bank harmless against any loss,
damage or claim, (direct, indirect and consequential) which may
be sustained as a result of the bank’s action in effecting the
reversal of the transaction/s and/or for instructing another bank
to reverse these transactions, which waiver and indemnity the
bank accepts, acting upon the instruction referred to above and
which purports to have been issued or authorised by you.
2. You further authorise the bank to debit the nominated account/s
for charges associated with the reversal request and you
indemnify the bank against any loss, damage or claim (direct,
indirect and consequential) that the bank may suffer because you
have not paid the costs or fees associated with this reversal
request.
3. By signing the below, you confirm that you have read and
understood the content of this document and you accept the
conditions and the indemnity and waiver herein.

Signature* Signature*
Who warrants Who warrants
that he/she is that he/she is
duly authorised duly authorised
thereto thereto

Name Name

Designation Designation

Please note that 2 signatories are required for business entities and only 1 signature for individuals

A division of FirstRand Bank Limited. An Authorised Financial Services and Credit Provider (NCRCP20).