Please fill in the below form and then click on “Generate PDF” button to generate the PDF format of the form. You can then print the generated PDF, sign at the provided spaces and submit the form at our nearest CB Branch or send the form attachment to email address.

Customer Transaction Dispute Form

Account Details
Cardholder Name*
Transaction occured card*
Telephone No
Mobile No*
Email ID*
"Mentioned below are some dispute reasons. Please select the applicable scenario and provide appropriate documentation as indicated. Please note, The Commercial Bank of Qatar will not be able to initiate dispute resolution unless the relevant documents are submitted along with the dispute form "
S.No Transaction Date Merchant Name Original Transaction Amount Disputed Amount *
* Please fill atleast one row

Note: In case you are disputing more than five transactions; please provide the transaction details in a separate sheet as an Annexure

Dispute Reasons : (Tick The Appropriate)
Unauthorised Transaction Neither I nor anyone authorised to use my account participated in or authorised the transaction My card was (Select one of the following choices below):
In my possession at the time of fraudulent use
Lost/Stolen: Date Location
Never received
Duplicate /multiple Processing I have been charged multiple times but have authorised only one transaction. The original amount appeared on my Statement (indicate statement period), a copy of which is enclosed.
Difference In Amount The amount on my sales slip differs from the amount billed. Attached is my sales slip showing the correct amount The difference amount disputed is QR
Cancelled Transaction I had cancelled the transaction / services on (DD-MM-YYYY). The reason for cancellation:
The cancellation numbers/confirmation provided by the merchant is (proof attached)
Paid By Other Means I had paid for the transaction by (specify the mode) for an amount of QR
Attached is a copy of proof of payment made by other means (Cheque/Cash/through other Credit or Debit Card)
Goods services Not Received I have ordered/booked the goods/services on (DD-MM-YYYY) , but not received the goods/services as on(DD-MM-YYYY)
I have contacted the Merchant on (DD-MM-YYYY). The merchant’s response to my request for the refund or delivery date is attached herewith.
Note: (The cardholder must attempt to resolve the dispute with merchant and should confirm the same in his/her complaint.)
Credit Not Received I was given a credit slip / credit confirmation for an amount of on (DD-MM-YYYY) by the merchant.
The above credit is not yet reflecting on my statement.
The credit is listed as a debit on my statement.
(Please attach the copy of the credit slip/ confirmation provided by the merchant).
Defective Merchandise/merchandise Not As Described I am disputing the goods/services received as Defective/Not as described. On the reverse I have detailed what goods/services were expected and what goods/services have been received. I have indicated my attempt to return the goods to the Merchant. (* Quality of services / merchandise cannot be disputed) I have received the goods on (DD-MM-YYYY) and returned on (DD-MM-YYYY) for the reason of
I have contacted the Merchant on (DD-MM-YYYY). The merchant’s response to my request for the return/refund is attached herewith.
(The cardholder should have returned or made an attempt to return the merchandise and must state so in the dispute.)
Atm Discrepancy ATM did not dispense cash but my account is debited for the amount of QAR
ATM partially dispensed cash for QR but my account is debited for the amount of QR on
(Attached is my copy of ATM slip.)
Item(S) Not Recognised I could not recognise/remember this transaction and I would request you to provide more details about the transaction(s).
* means mandatory
I accept terms, conditions and declaration
Kindly submit the signed form at our nearest CB Branch or send the form attachment to email address.