Transaction Dispute

All information is compulsory unless otherwise stated.

Name *

NRC/ Passport Number *

Registered Phone Number *

Registered Email Address *

Card Number *

Details of Dispute Transaction

Transaction is disputed at *

CB Bank

ATM

E-Commerce

POS Machine

Other Bank

Please describe the reason *

Transaction Date *

Transaction Time *

*** E.g., 02:30 PM ***

Transaction Amount *

Merchant Name/ ATM Location *

I confirm that the details given above are true and correct. I agree to comply with the terms and contitions applicable to the conduct of e-banking facilities which I have read and understood.