Adjustment Request Form
Case Summary
SR #
*
Complaint Date
*
-
Day
-
Month
Year
Date
Customer Segment
*
Please Select
Global Sales - GSL
Government - GOV
Key Accts & Banking & LE -KEY
Batelco - BTC
Medium Enterprise -SME
Wholesales - WSL
Special Accounts - RYL
Small Enterprise -SME
Banking & Finance
Beyon Solutions - BYS
Customer Name
*
Type of Service
*
Broadband
PSTN
Bulksms
Email Domain
Email User
Voicemail
Web Domain
Web Hosting
DataCom
PBX
ISDN
ICT
Free Link
E-Fax
Mobile
Devices
Print Bill Charges
Re-connection Charges
Maritime
AWS
UC
EVD
Service ID (Circuit Number, Tag)
*
Single Or Bulk?
Single
Bulk
Total of Service IDs Numbers Impacted
Activation Service Date
*
-
Day
-
Month
Year
Date
Dispute Type
Bill issue
Dispute Element
*
Monthly Rental
Once off
Tariffs/usage charges
Total Bill
Nice Number
SLA
Penalty Charges
VAT
Write off charges
Error Period
Single Period
Multiple Periods
Error Period Dates
*
Resolution Type
*
Please Select
Bulk Adjustment
Bill Adjusted
Win Win Situation
Management Decision
SLA
Covid-19
Correction Action
Please Select
Provide Order
Cease Order
Modify Order
Update Records
No action required
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Next
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Root Cause Reason
*
Human Error
Product/System Defects
Goodwill
Staff Name/Code
*
Adjustment Type
*
BHD Credit
USD Credit
Amount to be Adjusted
*
Adjustment REF #
*
Revenue Impact
*
Yes
No
Precaution Action
Case Details
Creator Email
example@example.com
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