牡丹卡账务查询申明书和非本人交易附加说明.docVIP

附表1： 牡 丹 卡 账 务 查 询 申 明 书 Transaction Inquiry Form *卡号 (Card No.)： *卡片有效期(Exp Date)： *交易日期(Trans Date)： 交易国家或地区(Trans Country/District))： *商户名称(Merchant Name)： *交易总额(Trans Amount)： *交易币种(Trans Currency)： （如为三笔（含）以上交易，请提供对账单复印件勾明具体交易）(With no less than three disputed transactions, please mark the transaction amount on the copy of the statement respectively) *查询类型(Transaction Type)： □消费(Consumption) □取现(Cash Withdrawal) □转账(Account Transfer) □利息及费用(Interest Commission) *查询交易币种(Trans Currency)：□人民币 (RMB) □外币(Foreign Currency) *查询内容 (Choice of Inquiry)： 1. □查询交易场所(Transaction Location )/商户名称(Merchant Name)： 2. □调阅单据，原因如下( Transaction Receipt Retrieval) □非本人交易（指交易非本人所为，亦未授权他人使用，卡在本人手中） Neither I, nor anyone else authorized by me engaged in this transaction. My credit card is in my possession,and the account number was used fraudulently. ………………以上调阅单据原因须填写《非本人交易附加说明》,以下无需填写《非本人交易附加说明》………………………… □记账金额和实际交易金额不符,交易金额为_____,不应为_____. The amount billed is incorrect. The Transaction Amount should be ____ not _____. □实际消费未成功，账户已被扣账 Transaction was unsuccessful, but the amount was debited to my account □退货交易未到账,退货凭证 □有 □无 The amount of the refunded goods has not been credited to my account. □定期付费交易已于_____日取消，但商户仍继续定期向本人账户中收费，本人已经尝试过和商户解决该问题。The merchant continues to charge my account for periodic billings to my account that I canceled on _____. I was speaking with ______ (if know) and have attempted to resolve this dispute with the merchant. □该笔消费本人已经以其他方式付过款，付款凭证附后，本人已经尝试和商户解决该争议。The charge listed was paid previously by another method. I am enclosing proof. I have tried to resolve this with the merchant. □本人已取消该预订，取消日期_____，取消号码______。I had cancelled the reservation. Date of cancellation______, cancellation number______. □跨境非面对面交易商品未收到或服务未获得 Merchandise not received or services not provided