Cardholder Disclaimer Form (Page 2 of 2) in pdf

Cardholder Disclaimer Form Page 2

AIB Cardholder Disclaimer Form

(For ATM & POS Debit Fraud/Customer Service Chargebacks)

To be completed by cardholder and returned to Debit Fraud, Card Issuing, Sandyford, Dublin 18

Additional Customer Comments:

(Any additional information which may be of relevance)

Cardholder's Authority:

I hereby authorise Allied Irish Banks,p.l.c. to make enquiries and to disclose relevent information

(including copy documentation) relating to my accounts and the attached transaction(s) to any third

party including the Gardaí as may be deemed necessary by the Bank for the purpose of investigating

this claim.

I have examined the transaction(s) debited from my account and dispute the transaction(s) as detailed

on the attached statement. I have underlined and initialled against each transaction that I am disputing.

I did not make the transaction(s) detailed or authorise any person to use my AIB Debit Card to make

this transaction(s).

I am aware that my account may be re-debited, if following investigation the transaction (s) are found to

be genuine or alternatively a merchant refunds my account directly.

Cardholder's Signature: ______________________________________

Date: _ _ / _ _ / _ _

For Office Use Only

Branch Comments:

Branch Date Stamp

Branch Checklist:

AIB Debit Card Dispute Form completed on Alimail*

Transaction Details Attached (Ledger and CQ41 / BI48)

Card MUST be Flagged Lost/Stolen- For Unauthorised/Missing in Post

Copy of Card History Attached

Staff Number: ___ ___ ___ ___ ___

*AIB Cardholder Disclaimer Form should only be completed following completion of AIB Debit Card

Dispute Form on Alimail

Allied Irish Banks, plc. Registered Office: Bankcentre, Ballsbridge, Dublin 4. Registered in Ireland. No. 24173.

Allied Irish Banks, p.l.c. is regulated by the Central Bank of Ireland.

Cardholder Disclaimer Form Page 2