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*

Transaction details:

The card number (first 6 and last 4 digits)*
Date and time of the transaction*
Transaction amount*
Transaction location *
The dispute reason*

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*
Have you tried to resolve the issue with a sales representative? Please describe who you talked to, when, and what answer you have received*
Add scanned copies of receipts and other documents confirming the transaction*
Не обрано

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.