1. To: Bank of China Credit Card Customer Service Centre Fax Number: 010-8297 0255
GWIC Cardholder Dispute Form
Credit Card No. Cardholder Name Statement Date Tel. No.
Transaction Date Merchant Name Transaction Amount
Part 1 :
Requesting for transaction record : I did authorize the above transaction(s). I would like to request the copy of
transaction receipt for my reference only. I agree to pay for the copy retrieval fee of HKD40/ USD5/ EUR4/ GBP3/ AUD5,
please debit my account stated above.
Requesting for dispute : I would like to request the dispute of transaction. (Please fill in Part 2)
Part 2 :
I will settle the transaction(s) first, please refund to me if I am not liable for the transaction(s).
I will not settle the transaction(s), please put the transaction on hold until the investigation results are known. I
understand that I will be liable for the disputed item together with the handling fee (if any) and accrued interest, if the
transaction(s) is proved to be authorized by me.
I would like to dispute the item(s) based on the following reason(s): (Please tick the appropriate box)
1. Unauthorized Use I did neither authorize nor participate in the transaction(s). My card was in my
possession at the time of the questioned transaction.
(Please enclose with the copies of front and back of your card)
2. Duplicated Charge I only authorized one transaction but the merchant charged more than once.
3. Participated in ____ I did authorize in _____ transaction(s) for amount $_______________ at the
Transaction(s) Only merchant, but I neither authorize nor participate in the above transaction(s) and my
card was in my possession at the time of the questioned transaction.
4. Incorrect Amount / Transaction amount should be $ _______________ at __________ (Currency).
Transaction Currency (Please enclose with your copy of transaction receipt)
5. Paid By Other Method I have settled the transaction(s) by □ cash □ others ___________________
(Please enclose with the copy of payment receipt)
6. Credit Not Received I have received a credit slip issued by the merchant but no refund is received.
(Please enclose with credit slip or any supporting document)
7. Non-receipt of Goods / The merchant was unable or unwilling to provide the ordered merchandise / services
Services to me, I have attempted to resolve with the merchant but in vain. (Please enclose
relevant supporting document stating the delivery date, etc…)
8. Cancelled Recurring I have informed the merchant to cancel my monthly/yearly agreement by written
Services request on __________(date) Nevertheless, my account was still billed.
(Please enclose the cancellation letter / form)
9. Cancelled Reservation at I have made a room reservation at the above Hotel but cancelled at __________
Hotel (am/pm) on (date)__________. I was given a Cancellation No._______________
10. Non Receipt of Cash at I did authorize and participate in the transaction(s) but □ did not receive cash
ATM OR □ received a partial amount $ _______________ from the ATM.
11. Others
Cardholder Signature 签署：
签署： Date 日期：
日期：
(Signature must be same as the one on Application Form 签字式样须与申请表相符)
Remarks: 1. I understand and agree that I must notify Bank of China in writing within 30 days from the date of the Statement for the contrary.
Otherwise, I shall be liable to the dispute transaction(s).
2. I understand and agree to pay for the handling fees stated in “Great Wall International Credit Card Fees Schedules” in result that I am
liable for the aforesaid transaction.
送：中国银行信用卡客户服务中心 传真机号码： 010-8297 0255
