CARDHOLDER DISPUTE FORM
NAME: DINESH KUMAR SAINI
CARD NUMBER:
4 0 2 9 X X X X X X X X 8 5 6 5
I am disputing the following transaction(s) for the reason given below and request you to settle the case(s):
DETAILS OF DISPUTED ITEM(S):
TRANSACTION DATE MERCHANT NAME TRANSACTION AMOUNT
31/10/2025 3.05 PM [4.35 IST] Triple X Restaurant Man Dubai Ae AED 2303 / INR 55677.37
Please select the most appropriate one:
q I have neither authorized nor participated in the above transaction(s). I confirm that the card is still in my
possession.
q My card was lost/stolen on __/__/____ and the same was reported to you on ______________.
q Duplicate/Multiple billing. I have done only one transaction for Rs. _______ at the Merchant Establishment
on __/__/____ but i was billed ____ times on __/__/____.
(Please attach a copy of actual transaction receipt / communication with merchant)
q I only authorized one transaction for Rs. ________ on ___ / ___ / ___. It appears to be processed for the
incorrect amount of Rs. ______________.
(Please attach a copy of transaction receipt and any other applicable documentation).
q I have cancelled the transaction(s)/returned the goods but have not received credit/refund for the same.
Expected date of credit ___ / ___ / ___.
(Please attach the cancellation copy / communication with merchant)
q I had received defective merchandise/goods and had returned the goods to the merchant on __/__/____.
q Please attach the communication with the merchant.
q Provide evidence for damaged / defective / not as described goods.
q Paid by alternate means. I gave my card for payment, but later paid by other means for the same
transaction. I Paid by Cash (attach cash receipt/bill)/ Cheque (attach Cheque /Bank statement)/ other card
(attach transaction receipt/other card statement)
q Cancelled Membership/Subscription/Booking.
(Please attach the cancellation proof / communication with merchant)
q I ordered goods/services and the same were expected to be delivered by date (dd/mm/yy)___________, but
I never received the same.
(Attach the proof of order placed / communication with merchant)
q Cash was not dispensed at the ATM but I was billed for the entire amount of Rs. _____________.
(Attach the transaction receipt)
q Cash was dispensed partially in the ATM for Rs. ___________ but I was billed for the entire amount of
Rs. __________.
(Attach the transaction receipt)
q Others (Please explain in detail. Please attach necessary supporting document)
During my visit, the total bill presented to me was ₹600, which included complimentary drinks. However, upon
settlement, I noticed that an additional “BL Code (Blue Label)” charge was added without my consent. When I
questioned this, the staff assured me that the charge would be adjusted. Shortly after, I received a message
confirming a deduction from my card for the higher amount, followed by a message stating that the previous
transaction would be reversed.
Despite these assurances, the amount was not reversed, and the full unauthorized amount was deducted. I
immediately blocked my card and raised a complaint with the bank regarding this fraudulent transaction. I
also attempted to contact the hotel management for clarification, but they failed to respond to calls or provide
any written explanation.
Upon further investigation, I discovered multiple online reports and complaints indicating that this
particular merchant has been involved in similar unauthorized or fraudulent activities, raising serious
concerns about their business practices and integrity.
Relief Sought
In view of the above, I request the following actions:
1. Immediate reversal of the unauthorized transaction amount to my account.
2. A thorough investigation into the merchant’s activities and transaction legitimacy.
3. Temporary suspension or re-verification of the said merchant by the acquiring bank, given the
multiple online complaints suggesting possible fraudulent conduct.
4. Confirmation from your side once the investigation and corrective actions are complete.
Please consider this a formal complaint under applicable banking regulations, consumer protection laws,
and RBI guidelines on unauthorized electronic transactions. I am enclosing all relevant transaction
records, screenshots, and communication attempts for your reference.
Mandatory: For resolution of the dispute, please forward the duly signed and filled CDF along with the applicable
documents.
DECLARATION:
I declare that above given information is true and correct to my knowledge. I understand that I can be held liable
for all charges incurred if dispute raised by me is found invalid. I agree to pay the charges levied by the bank for
the same including the cost incurred for investigation of my claim. The Bank may contact me whenever it requires
any further information.
Email/Phone / Fax: [Link]@[Link] / +919888780808 Date: 31/10/2025
Address: B6, Jaypee Klassic, Noida Cardholder's Signature: __________________