Transaction Dispute RequestImportant Information about your PrivacyFirst Option Bank takes your privacy seriously. To see how we handle your personal information, please download and retain a copy of our Privacy Notification.Your DetailsMember Number *Full Name *Preferred Contact Number *Email Address *Transaction Type *VisaATMEFTPOSBPAYOSKOFunds TransferVISA Transaction DetailsCard Number (first 4 digits) *Please select an optionPlease choose44344133Card Number (last 4 digits) *Date of Transaction 1 *Merchant Name *Amount *AUDDate of Transaction 2Merchant NameAmountAUDDate of Transaction 3Merchant NameAmountAUDDo you have more disputed transactions?NoYesDate of Transaction 4Merchant NameAmountAUDDate of Transaction 5Merchant NameAmountAUDDate of Transaction 6Merchant NameAmountAUDDo you have more disputed transactions?NoYesIf so, please email them to [email protected]Dispute ReasonUnauthorised Transaction - Transaction not authorised by Primary or Additional cardholder. The card was in my possession at the time of the transaction. Note: The card will be cancelled and a replacement card will be issued (subject to replacement card eligibility policy)Duplicate Billing - I was charged more than once for a single authorised transaction. I have not authorised the other transaction(s). My card was in my possession at the time of the transaction.Non-Receipt of GoodsRefund/Credit not Processed - Credit transaction receipt issued but credit not processed to my account.Goods returned to Merchant but Refund not Processed.Cancelled Membership/SubscriptionPaid by other means - The transaction was charged to my account and was also paid by other means.Incorrect Amount ChargedServices not Rendered - Services for the transaction(s) were not rendered due to the inability/unwillingness of the merchant. I have attempted to resolve this dispute with the merchant and/or merchant’s liquidator.Cancelled Accommodation - Accommodation was booked and cancelled within cancellation policy.Other - If your dispute does not fall into any of the above categories, please provide a detailed explanation of the circumstances surrounding your dispute below.Select one optionIf Other, please provide detailsWhere did you use the card? *Over the phone or internetAt a physical locationPlease select one optionWas this transaction authorised by yourself?YesNoPlease be aware some merchants may appear under a different name on your statement.Have you (or someone you know) used your card for access to any mobile phone programs or gaming consoles?YesNoA subscription may be set up for add-ons to games, e.g. Apple, Xbox, MicrosoftNotesPlease contact the merchant prior to lodging a dispute - we may not be able to lodge these on your behalfAny PayPal transactions need to be disputed through PayPal themselves as they have their own dispute resolutionPlease contact PayPal directly - we are NOT able to lodge these on your behalfDid you provide any extra verification details?YesNoe.g. Date of birth, pet's name or CVV (3 digits on back of card)Did you sign up for a Free Trial or similar offer?YesNoIf Yes, please attach any correspondence with the merchant alongside dates of the order and the cancellation.Have you attempted to contact the merchant to cancel your subscription?YesNoIf No, please contact the merchant prior to lodging a dispute.Card used at a Physical LocationHas your card been Lost or Stolen (if not authorised by yourself)?YesNoIf either of these apply, First Option will stop your card and issue a new one (delivery of new card is 7-10 days).How did you pay?payWave (Tap & Pay)Insert Card with chip and entered PINSwipe magnetic strip and entered PINSignatureSelect one optionBPAY Transaction DetailsTransaction 1Account NumberTransaction DateAmountAUDBiller NameReceipt NumberTransaction 2Account NumberTransaction DateAmountAUDBiller NameReceipt NumberFunds Transfer DetailsAccount NumberTransaction DateAmountAUDRecipient BSBRecipient Account NumberRecipient Account NameOsko DetailsAccount NumberRecipient PayID or Account NumberTransaction DateAmountAUDATM Transaction DetailsAccount NumberCard Number (Last 4 Digits)AmountAUDTransaction DateATM LocationTransaction TypeSelect TypeWithdrawalDepositDid the ATM Malfunction?YesNoAmount RequestedAUDAmount ReceivedAUDWas your card captured?YesNoWas the transaction authorised?YesNoIs the card in your possession?YesNoHave you previously reported the card as lost or stolen?YesNoWho did you report it to?Have you disclosed your PIN to anyone?YesNoEFTPOS DisputeAccount NumberCard Number (Last 4 Digits)AmountAUDTransaction DateTransaction TypeSelect TypeWithdrawalDepositDispute TypeSelect TypeUnauthorised TransactionDuplicate TransactionUpload DocumentsUpload DocumentationChoose FileNo file chosenDelete uploaded filee.g. Receipt, letter, invoice, notice, etc.Document 2 (if required)Choose FileNo file chosenDelete uploaded filee.g. Receipt, letter, invoice, notice, etc.Document 3 (if required)Choose FileNo file chosenDelete uploaded filee.g. Receipt, letter, invoice, notice, etc.Document 4 (if required)Choose FileNo file chosenDelete uploaded filee.g. Receipt, letter, invoice, notice, etc.Submit
