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CAM Dispute Form Fillable

This document is a dispute/request form for transactions made using a cash deposit machine. It requests information from the user such as name, account and contact details. It also requests details of the disputed transaction such as date, time, terminal ID, destination account and amount. The type of dispute can be an uncredited deposit, unposted bill payment, deposited to the wrong account or posted to the incorrect biller. All disputed transactions are subject to investigation and disputes beyond 60 days need to indicate the reason for late reporting.

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Jeancel Revi Cortel
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175 views

CAM Dispute Form Fillable

This document is a dispute/request form for transactions made using a cash deposit machine. It requests information from the user such as name, account and contact details. It also requests details of the disputed transaction such as date, time, terminal ID, destination account and amount. The type of dispute can be an uncredited deposit, unposted bill payment, deposited to the wrong account or posted to the incorrect biller. All disputed transactions are subject to investigation and disputes beyond 60 days need to indicate the reason for late reporting.

Uploaded by

Jeancel Revi Cortel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CASH DEPOSIT MACHINE DISPUTE/REQUEST FORM

Cash Deposit Machine User Information


Cash Deposit Machine User Name (Last, First, Middle Name)

Card Number Account Number

Branch of Account/Card Issuing Branch/Unit Home Address

Landline Mobile Number Fax Number Email Address

Transaction Dispute Details

Destination Account/Amount
Date Time Terminal ID Remarks
CASA/Cash Card Account Subscriber No./ Institution Amount Claimed

Type of Dispute/Request

Uncredited Deposit via Cash Deposit Machine Other Request


Unposted Bills Payment via Cash Deposit Machine Deposited to incorrect destination
Certification Letter account
Posted to incorrect biller

Terms and Conditions

All disputed transactions are subject to investigation. For disputed transaction beyond 60 days from transaction date (kindly indicate reason why the transaction/s was/were
not immediately reported to the bank).

Name / Signature / Date

Email this completed form Reference guide in accomplishing the form

To : [email protected] Date Date of deposit/payment


Subject : CDM Dispute Form_Case ID No. XXXXX Time Time of deposit/payment
(Indicate case ID number provided by BDO CCC) Terminal ID Terminal ID where the deposit/payment was made
CASA/Cash Card Account No. Indicate destination account number or cash card number encoded during deposit
or call
Subscriber No/Institution Reference/Subscriber number (for bills payment only)
(02) 631-8000 Institution Name Company/Biller (for bills payment only)
for Customer Service Assistance Amt Claimed Amount that should be deposited to the destination account
Remarks Indicate additional remarks if needed

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