The application to dispute a POS terminal transaction/ Internet

The form is for the first request only. It is not used for repeated requests for the same transaction.

General information about a Customer:

Full name*

TIN (Tax identification number)*

Phone number*

Email*

Transaction details:

The card number (first 6 and last 4 digits)*

Date and time of the transaction*

Transaction amount*

Also, please provide any other information and additional clarifications on the merits of the dispute that you have available and contributing to a favorable resolution of the dispute:

Please describe the details of the circumstances that caused the need to dispute the transaction*

Upload files of the following formats here: png/jpg/doc/docx/pdf up to 25 MB.

Attach the document

Not selected

No file

The Bank is not responsible for the outcome of the appeal in case of failure to provide the client, or late submission of all necessary documents / explanations (specified in the form) for the appeal process.

The screen provided by FUIB's Online program is not a document that can be used as a justification for initiating an appeal.

I understand and agree that if this claim is granted, the disputing transaction funds will be credited to my current account without the Bank sending a written response to this appeal.