________
________
Telephone: ________
Email: ________
________
Attention: ________
________
Date: ________
RE: NOTICE OF DISPUTED TRANSACTION / BILLING ERROR
Account Number: ________
Card / Facility Number (if applicable): ________
Dear Sir or Madam,
1. Purpose of this letter
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1.2 This letter constitutes a formal dispute and complaint for the purposes of your internal dispute resolution procedures.
2. Particulars of the disputed transaction
2.1 The following transaction was debited from my account. I did not authorise this transaction, I do not recognise it, and it does not reflect any goods or services received by me:
- Amount of transaction: $________ (________)
- Date of transaction: ________
- Transaction reference / receipt number: ________
- Merchant / payee description as shown on statement: ________
- Date of statement on which the error appeared: ________
2.2 To the best of my knowledge and belief, the particulars set out above are true and correct.
3. Supporting material
3.1 A copy of the statement on which the disputed transaction appears is enclosed with this letter, with the relevant entry marked for your reference.
3.2 Any further documents relevant to this dispute are described as follows: ________.
4. Request and remedies sought
4.1 I request that you:
- (a) promptly investigate the disputed transaction;
- (b) reverse and credit to my account the full amount of the disputed transaction; and
- (c) reverse and credit to my account any associated transaction fees, interest, default charges or other amounts that have accrued as a result of, or in connection with, the disputed transaction.
4.2 Pending the outcome of your investigation, I request that you place a hold on any further interest, fees or recovery action in respect of the disputed amount.
4.3 I request that you confirm in writing the outcome of your investigation and the steps taken to correct the error.
5. Time for response
5.1 In accordance with the ePayments Code and your internal dispute resolution obligations, I expect you to acknowledge this complaint promptly and to provide a written response within ________ days of the date of this letter, or within such shorter period as may be required by the applicable code or regulation.
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6. Reservation of rights
6.1 Nothing in this letter is to be taken as an admission of liability on my part, a waiver of any of my rights, or an acknowledgement of any debt, and all of my rights are expressly reserved.
7. Further information and contact
7.1 Should you require any further information from me in order to investigate and resolve this matter, please contact me using the telephone number or email address provided above.
I look forward to your prompt response and to the timely resolution of this matter.
Yours faithfully,
________
Signature: ________
Date: ________
Enclosure: Copy of statement showing the disputed transaction.