Transaction Dispute Form IB

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Transaction Dispute Form IB

(For Mobile and Internet Banking)

Customer Details

Customer Name:

Sender Mobile Number:

Sender Account Number:

Email Address:

Date Dispute Received:

Transaction Details

Channel used	Date of Transaction	Amount in Birr	Beneficiary Account number	Beneficiary bank
Channel used: MobileInternet	Date of Transaction:	Amount in Birr:	Beneficiary Account number:	Beneficiary bank:

Dispute Reason

Based on my examination of my account statement or inquiry with your customer service, I am disputing the transaction listed above based on the following:

Dispute Reason:
Amount DeductedOther

Other reason:

Declaration

I hereby declare that all information provided in this dispute form is true to the best of my knowledge and the attachments are genuine and valid.

Signature:

Date:

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