Dispute Claim

Type of Dispute *

Select any one type of Dispute

Name of Account Holder *

Full Name of Account Holder

Transaction Date *

Transaction Bank/Merchant/ATM *

Please specify the transaction destination Bank or Merchant or ATM owner Bank

Card Number

For Debit Card Only. Mandatory for ATM/POS Dispute.

Mobile Number *

Must be same mobile number for mobile banking

Account Number *

20 digit account number

Claim/Dispute Amount *

Location of Transaction

Please specify the location of transaction or Merchant or ATM.

Other Description (If any)

To be filled by bank professionals only

Tran ID

Trace ID

Name

.

Designed by: IT Department, EDBL

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