BigPay Malaysia Sdn Bhd DISPUTE FORM
Cardholder Name
(Full name as per NRIC/passport)
Card Number
(Last 4 digits only) ************XXXX
Phone
E-mail
I hereby dispute the following transaction(s):-
Transaction Date Transaction Description Amount
Reason(s) for dispute and enclose supporting document(s) where applicable :-
I do not recognise the transaction(s).
I have not authorised or participated in the transaction(s).
Duplicate transaction(s).
I have cancelled the above transaction on _____________ (date). I last contacted the merchant about this matter on __________ (date).
*Enclose proof of cancellation.
I cancelled the reservation with the above hotel on ___________ (date) and the cancellation code is ________________. *Enclose proof of
cancellation.
Amount charged differs. I authorised ____________ (amount) but amount debited was _____________ (amount). *Enclose proof of payment.
I paid for the goods or services by other means and my card / account was debited. *Enclose proof of payment.
A credit/refund was not processed for___________ (amount) on __________. Merchandise was returned / Services were cancelled on
__________ (date). I last contacted the merchant about this matter on __________ (date).
The goods or services I have paid for were damaged / defective or not as described. I returned the goods / cancelled the services on
_________ (date). I have contacted the merchant to try and resolve this matter on _____________ (date).
Other (please specify):_________________________________________________________________
Declaration :-
I understand that the dispute form must be submitted to BigPay Malaysia Sdn Bhd within forty (40) days from the date of the transaction(s),
failing which, I will be liable for the mentioned transaction(s).
I declare that the above given information is true and correct to my knowledge. I understand that I can be held liable for all charges incurred
if the dispute raised by me is found invalid. I further agree to indemnify BigPay Malaysia Sdn Bhd against all other costs, expense & charges
that may incur in the verification processes of the disputed transactions.
I agree that I shall be liable for all transaction(s) abovementioned, in the event verifications made by BigPay Malaysia Sdn Bhd reveal that
the abovementioned transaction(s) was (were) accurate, genuine and properly authorized by me.
Signature Name Date
ADDITIONAL Please be advised that Visa/MasterCard requires that attempts must first be made to resolve your dispute with the
NOTE: merchant before notifying us. In the event if the above transactions are identified as fraudulent, we may be required
to block your Card.
