12/06/2023
Note: Please fill, print, sign and deliver it to the branch.
Card Dispute Form / نموذج إعتراض البطاقات
Type of Dukhan Bank Card
Credit Card
Debit Card
Card Number
I confirm the card was always in my possession.
Yes
No
Please choose the dispute reason from the following list:
Duplicate Billing
Incorrect Amount
Refund / Credit not received
(please attach credit voucher)
Cancelled transaction
(please attach cancellation proof)
Paid by other means
(please attach proof of payment)
Not participated or unathorized transaction
Cash not dispensed from ATM
Service / Goods not received
(please attach support documents)
Defected merchandise or not as described
Need more information
If none of the above applies, please clarify the reason for complaint.
Cardholder name
Mobile number
Account number
Email address
I understand that the investigation may take up to 180 days. I understand that all required and supporting document(s) must be provided as and when requested.
Transaction / معاملة
Transaction Date
(MM/DD/YYYY)
Merchant Name
Transaction Amount
EUR
AED
AUD
BHD
CAD
CHF
EUR
GBP
HKD
INR
JPY
KWD
OMR
QAR
SAR
SGD
USD
Reference Number