AU 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
Cardholder Name*

First NameLast Name
Card Number:*
Last 4 digits of your card number
Contact Number:*
Email Address:*
example@example.com
Y-Number: *
10 digit number at the bottom left corner or back of your card
2. What transactions are you disputing?

If you are disputing for more than 10 transactions, please attach the transaction statement and highlight the disputed transactions.
Number of disputed transaction*
Transaction 1
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 2
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 3
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 4
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 5
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 6
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 7
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 8
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 9
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
Transaction 10
Merchant Name:   Merchant Name
Transaction Date:   DD/MM/YYYY
Transaction Ref No.:   Transaction Ref No
Transaction Amount:   Transaction Amount
Currency:   Currency
More than 10 transaction. Please attach transaction statement and highlight the disputed transactions*

Tap on any of the currency wallets displayed at the top of your homepage to download the statement. Extract the statement as a pdf document by tapping the "Share" icon at the top right corner of the screen.
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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.
3.1 Unauthorized transactions that are more than 45 days old or involve more than 35 transactions.3.2 Duplicated billing3.3 Paid by other means3.4 Incorrect amount3.5 Goods and/or Services not; received or rendered / not as described / defective3.6 Refund / Credit not processed3.7 Cancelled recurring membership / subscription3.8 Other
3.1 Unauthorised transaction(s)

Please note that we will block and suspend your account to protect your from any further unauthorised transaction.
3.1.1 I have NOT transacted with the merchant before and I did NOT authorise the above transaction(s)3.1.2 I have transacted with the merchant before but I did NOT authorise the above transaction(s)
3.1.1.1.1 in my possession3.1.1.1.2 lost/stolen
3.1.1.1.2.1 the card was lost/stolen onDD/MM/YYYY
3.1.1.1.2 I did perform the transaction on DD/MM/YYYY at name of merchant for currency and amount but did NOT authorise the other transactions. The card was in my possession at the time of the transaction.
3.2 Duplicated billing

Condition: Duplicate transactions must have exactly the same amount, date, currency and merchant.
I was charged more than once for a single authorized transaction (same transaction date & amount)
I did perform the transaction on DD/MM/YYYY at name of merchant for currency and amount but did NOT authorize the other transactions. The card was in my possession at the time of the transaction.
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 have already paid the transaction by other means Cash Cheque Others please state payment method
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)
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) currency and amount instead of currency and amount
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*

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3.5 Goods and/or Services not; received or rendered / not as described / defective

Conditions: Cardholder must attempt to resolve with merchant prior to obtaining a refund, Cardholder did not receive the merchandise / service, Merchandise / service was received but in a damaged / defective-state, or did not tangibly match the description of the anticipated merchandise.
I have received goods/merchandise please provide detailswhich were not as described or defective. I have returned it to the merchant on DD/MM/YYYY with tracking/invoice number of . However, my refund is not received yet.
Details of the merchandise / service purchasedInvoice showing 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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3.6 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 ofcurrency and amount is not received.
The transaction was cancelled by the merchant on DD/MM/YYYY with the cancellation code of .
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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3.7 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 DD/MM/YYYY .
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*

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4. Your declaration
- I declare that all information provided is true and accurate, and that the reason selected above best describes my situation to the best of my knowledge.
- I understand and accept that You Technologies Group (Australia) Pty Ltd cannot guarantee the recovery of the disputed amount, as the outcome depends on the merchant’s processing bank and the rules of the Mastercard Chargeback Guide (available upon request).
- I acknowledge that the investigation may take up to 9 weeks for simple cases and up to 12 weeks (or longer) for complex cases.
IMPORTANT:

Once you have submitted this form, our team will process your dispute accordingly.

For enquiries, you may email us at: customer.au@you.co
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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 Goods and/or Services not; received or rendered / not as described / defective

3.6 Refund / Credit not processed

3.7 Cancelled recurring membership / subscription

4. Your declaration