招商银行信用卡 CHINA MERCHANTS BANK CREDIT CARD.doc

招商银行信用卡 CHINA MERCHANTS BANK CREDIT CARD 持卡人疑问交易声明书 CARDHOLDER’S STATEMENT 持卡人姓名 C/H NAME ： 信用卡卡号Card No.: 本人委托招商银行将下列声明及相关文件交于商户所属的收单银行，代本人反映争议款项。 （请写下争议款项的明细并在符合您声明的情况前打“√”） I entrust China Merchants Bank to transfer this statement and related documents to the acquirer banks and dispute the payments below on my behalf. （Please write down the details of the dispute transaction(s) and choose your proper condition with √.） 交易日期 TRANS.DATE 商户名称 MERCHANT NAME 金额 TRANS AMOUNT （ ）1. 本人从未授权过上述消费，且未授权他人使用此卡,也未透露过信用卡数据予他人。本人一直依从招商银行约定条款妥善保管本人的信用卡。 I have never participated in or authorized the above mentioned transaction(s). And I neither made it nor authorized any one to make the above stated transaction(s), and the card was in my possession at the time of the disputed transaction(s).） （ ）2. 本人确实于_____年___月___日到过此商店，并消费了一笔金额_______(美金/人民币)，但上述款项并非本人的消费。本人一直遵守招商银行的规定，妥善保管本人的信用卡，且卡片一直在身上，并未借予或授权他人使用。 I really went to this shop on _______ (date), and made the transaction in amount of ________ (RMB/USD). But I did not involve in the above mentioned transaction and always kept the card with me, never lent or delegated it to the others. （ ）3. 本人已参与上述交易，但此笔交易已用其他方式支付，（ ）现金、（ ）支票、（ ）其他卡。（若有发票或其它凭证，请附上。若您已与商户联系，请于备注栏填写您与商户的联系情况说明）。 This transaction has been paid by（ ）cash、（ ）check、（ ）other card(s)。 (Please enclose the invoice or other receipt and explain the details in the Comments Section if available). （ ）4. 本人已于_____年___月___日撤销此笔交易（ ），或已于_____年___月___日退货（ ）。（若有交易撤销或退货凭证，请附上。 若您已与商户联系，请于备注栏处填写您与商户的联系情况说明） I have cancelled this transaction on ________ (date) ( ), or have returned the sales on ________ (date) ( ). (Please enclose the cancellation/return voucher and explain the details in the Comments Section if available). （ ）5. 上述款项在本月信用卡账单中重复扣款，消费____笔，扣款____笔。 I was duplicated charged. I only made ___ transaction(s), but was charged ____ transactions. （ ）6. 本人已参与上述交易，但商户无法或不愿向本人提供有关交易的货物/服务 （请于备注栏内详细说明并填写您与商户的联系情