YouBiz Chargeback Form

Cardholder Transaction Dispute & Chargeback Form

To help us process your request, please submit this form within 45 days from the transaction date.
1. Your Details
Corporate Entity Name*
Cardholders Name*
Full Name as per ID
Card Number (Last 4 digits)*
Contact Number*
U-Number*
U-XXXXXXXXXX found at the back of your card
Email*
example@example.com
2. What transactions are you disputing?

If you are disputing for more than 3 transactions, please fill up a new form.
Number of disputed transaction*
Transaction 1
Merchant Name:Merchant Name
Date:Date
Reference Number:Reference Number
Transaction Amount:Transaction Amount
CurrencyCurrency
Transaction 2
Merchant Name:Merchant Name
Date:Date
Reference Number:Reference Number
Transaction Amount:Transaction Amount
CurrencyCurrency
Transaction 3
Merchant Name:Merchant Name
Date:Date
Reference Number:Reference Number
Transaction Amount:Transaction Amount
CurrencyCurrency
3. Why are you raising this dispute?

Please attach the relevant documents to support your dispute. Refer to each specific reason for the conditions and supporting document/s required. If you are disputing for multiple disputed transactions with different reasons, please complete one form for each dispute reason.
Please select only one option below and provide supporting document*

3.1 Unauthorised transaction(s)3.2 Duplicated billing3.3 Paid by other means3.4 Incorrect amount3.5 Merchandise not received / Service not rendered3.6 Goods received but not as described / defective3.7 Refund / Credit not processed3.8 Cancelled recurring membership / subscription3.9 Others
3.1 Unauthorised transaction(s)

Please note that we will block and suspend your account to protect your from any further unauthorised transaction.
3.1.0 I did not authorise the above transaction(s) and the card was

3.1.1 in my possession3.1.2 lost or stolen
3.1.2 lost or stolen on Date
3.2 Duplicated billing

Condition: Duplicate transactions must have exactly the same amount, date, currency and merchant.
Supporting documents required (Please tick on the documents provided)

Transaction receipt of your original transactionRecord to show attempt(s) made to contact with the merchant and resolve the dispute (email correspondences) if any
Documents Upload*

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3.3 Paid by other means

Conditions: The transaction has already been paid via other means (cash, cheque or others), Cardholder must attempt to resolve with merchant prior to obtaining a refund.
I've already paid this transaction by:

CashChequeOther
Supporting documents required (Please tick on the documents provided)

Proof of payment - cash receipt for cash payment or bank / card statement for cheque or credit card paymentRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences) were unsuccessful
Documents Upload*

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3.4 Incorrect Amount

Condition: Wrong amount or currency charged by the merchant.
The amount billed to my card is different from the amount that I had authorised. I should be billed in (currency) Type a label and (amount) Type a label
Supporting documents required (Please tick on the documents provided)

Invoice showing the authorised amount and currency for the transactionRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences) were unsuccessful
Documents Upload*

Cancelof
3.5 Merchandise not received / Service not rendered

Conditions: Cardholder did not receive the merchandize / service. Cardholder must attempt to resolve with merchant to obtain a refund
I have not received the merchandise / service / cash of (please specify) Type a label on Date and / or at (the agreed venue/location) Type a label
Supporting documents required (Please tick on the documents provided)

Details of the merchandize / service agreementInvoice showing the expected merchandize / service value and transaction dateProof of delivery notice showing the expected delivery dateRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences)
3.6 Goods received but not as described / defective

Conditions: Merchandize / service was received but damaged or did not materially match the description of the merchant. Cardholder must attempt to resolve with merchant to obtain a refund
I received goods/merchandise (please provide details) of Type a label which were not as described or defective. I returned it to the merchant on (date) Date with tracking/invoice number Type a label . However, my refund is not received yet
Supporting documents required (Please tick on the documents provided)

Details of the merchandise / service purchasedInvoice indicating the expected merchandise / service value and transaction dateProof of delivery notice indicating the expected delivery date and periodRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences) were unsuccessful.
Documents Upload*

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3.7 Refund / Credit not processed

Conditions: Refund or cancellation of payment agreed and issued with document proof, Merchandise returned or service cancelled but no credit voucher issued and cardholder not informed of refund/cancellation policy.
The merchant has agreed to cancel the transaction but the refund/credit of (currency & amount) Type a label is not received. The transaction was canceled by the merchant on Date with the cancellation code of Type a label
Supporting documents required (Please tick on the documents provided)

Void transaction note issued by merchant stating amount, date and card numberFor returned goods, proof of return and acknowledgement by merchant and invoice for returned shippingRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences) were unsuccessful
Documents Upload*

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3.8 Cancelled recurring membership / subscription

Condition: Recurring subscription / transaction continues even after cancellation notice has been made and accepted
I was charged for a recurring charge that was already cancelled. The cancellation was acknowledged by the merchant on Date
Supporting documents required (Please tick on the documents provided)

Document proof with date to show cancellation made and agreed by merchantRecord to show attempt(s) made to contact with merchant and resolve the dispute (email correspondences) were unsuccessful
Documents Upload*

Cancelof
3.9 Others
Documents Upload*

Cancelof
4. Your declaration
- All Information provided is true and accurate, and the reason for the dispute describes my situation In the most accurate manner, to the best of my knowledge.
- I understand that there will be a chargeback processing fee of SGD20 for each chargeback request. The fee will be waived if your chargeback request is successful.
- I understand and accept that You Technologies Group is unable to guarantee the recovery of the disputed amount, and that the results of the investigation is dependent on the investigation of the merchant processing bank and the governing rules and regulations of the Mastercard Chargeback Gulde which is available upon request.
- I understand and accept that the Investigation may take up to 9 to 12 weeks for resolution.
Cardholder's Signature

Clear
Date

MonthDayYear
Date
Please verify that you are human*
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Cardholder Transaction Dispute & Chargeback Form

1. Your Details

2. What transactions are you disputing?

3. Why are you raising this dispute?

3.1 Unauthorised transaction(s)

3.2 Duplicated billing

3.3 Paid by other means

3.4 Incorrect Amount

3.5 Merchandise not received / Service not rendered

3.6 Goods received but not as described / defective

3.7 Refund / Credit not processed

3.8 Cancelled recurring membership / subscription

3.9 Others

4. Your declaration