ATM Transaction Dispute Form

User Guide: ATM Transaction Dispute Form

This user guide will help you understand how to properly fill out and use the ATM Transaction Dispute Form.

Overview

The ATM Transaction Dispute Form is designed to help you formally report and dispute unauthorized or incorrect ATM transactions with your financial institution. This digital form can be filled out online and then printed for submission.

How to Use the Form

Step 1: Access the Form

• Open the form in your web browser
• Read the instructions at the top of the form carefully

Step 2: Fill Out the Form Sections

Personal Information Section

• Full Name: Enter your complete legal name as it appears on your bank account
• Account Number: Provide your bank account number associated with the disputed transaction
• Phone Number: Enter a contact number where you can be reached
• Email Address: Provide an email address for communication (optional but recommended)
• Street Address: Enter your complete residential address
• City, State/Province, ZIP/Postal Code: Provide your complete location details

Disputed Transaction Details

• Transaction Date: Select the date when the disputed transaction occurred
• Dispute Amount: Enter the exact amount of the disputed transaction
• ATM Location: Provide the physical location of the ATM used
• ATM ID/Number: If available, enter the ATM identification number (often found on receipts)
• Transaction Description: Briefly describe the transaction (e.g., "Cash withdrawal")
• Transaction ID/Reference Number: Enter the unique transaction identifier from your statement

Reason for Dispute

• Select all applicable reasons for your dispute:
  • Unauthorized transaction
  • Incorrect amount charged
  • Duplicate transaction
  • Cash not received
  • Other (requires explanation)
• Detailed Explanation: Provide a clear, chronological account of what happened

Supporting Documentation

• Check all documents you will submit with the form:
  • Account statement showing transaction
  • ATM receipt
  • Copy of government-issued ID
  • Other supporting documents
• Document Details: List any additional documents you're including

Declaration

• Read the declaration carefully
• Check the box to confirm your understanding and agreement
• Provide your signature (type your full name)
• The current date will be automatically filled in, but you can change it if needed

Step 3: Print and Submit

• Click the "Print Form" button to generate a printable version
• Review the printed form for accuracy
• Gather all supporting documents listed
• Submit the completed form and documents to your financial institution
• Keep a copy for your records

Important Notes

• Fields marked with an asterisk (*) are required
• Provide as much detail as possible to help resolve your dispute quickly
• Submit the form as soon as possible after discovering the disputed transaction
• Follow up with your financial institution if you don't receive confirmation of your dispute

Troubleshooting

• If the print button doesn't work, use your browser's print function (Ctrl+P or Cmd+P)
• Ensure JavaScript is enabled in your browser for the best experience
• If you need to save a digital copy, use your browser's "Print to PDF" feature

Security Considerations

• Only print the form on a secure printer
• Store copies in a safe location
• Shred any drafts or unwanted copies containing personal information
• Submit the form directly to your bank through secure channels

If you have any questions about specific form fields or the dispute process, contact your financial institution for guidance.