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    ATM Claim Form

    Uploaded by

    Jm Venki
    This is an ATM claims form for a customer to request a refund from their bank for an ATM transaction. The form collects information about the disputed transaction including the amounts requested and dispensed, the date and time, as well as details about the ATM like its ID and location. It also gathers information about the customer like their name, account and card numbers. The customer must provide their signature, contact details, and the date to submit the completed form describing the nature of their complaint.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    ATM Claim Form

    Uploaded by

    Jm Venki
    474 views1 page
    This is an ATM claims form for a customer to request a refund from their bank for an ATM transaction. The form collects information about the disputed transaction including the amounts requested and dispensed, the date and time, as well as details about the ATM like its ID and location. It also gathers information about the customer like their name, account and card numbers. The customer must provide their signature, contact details, and the date to submit the completed form describing the nature of their complaint.

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    ATM Claim Form

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    This is an ATM claims form for a customer to request a refund from their bank for an ATM transaction. The form collects information about the disputed transaction including the amounts requested and dispensed, the date and time, as well as details about the ATM like its ID and location. It also gathers information about the customer like their name, account and card numbers. The customer must provide their signature, contact details, and the date to submit the completed form describing the nature of their complaint.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    474 views1 page

    ATM Claim Form

    Uploaded by

    Jm Venki
    This is an ATM claims form for a customer to request a refund from their bank for an ATM transaction. The form collects information about the disputed transaction including the amounts requested and dispensed, the date and time, as well as details about the ATM like its ID and location. It also gathers information about the customer like their name, account and card numbers. The customer must provide their signature, contact details, and the date to submit the completed form describing the nature of their complaint.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ATM CLAIMS FORM To The Branch Manager, [Bank Name] ___________________________

    [Branch Name] *___________________________ [City] ___________________________

    I 1 2 3 II 1 III A Amount Requested for withdrawal Amount Disbursed by at ATM Amount to the account debited Date of transaction Time of transaction Other information B C Captured by the ATM Other complaints ATM ID / Location / Name of ATM Bank Name of the Customer Account Number Debit / ATM Card Number

    Customer information

    ATM Information

    Nature of the Complaints


    Rs. Rs. Rs.

    Signature of the Card holder.

    Mobile no :

    Date : ________________

    Tel no

    * Name of the bank branch where card holder account is maintained which is linked to the ATM.

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