牡-丹-卡-账-务-查-询-申-明-书(2015).docVIP

附表1：牡丹卡账务查询申明书

TransactionInquiryForm

卡号(AcctNo)：卡片有效期(ExpDate)：交易日期(TransDate)：

交易国家或地区(TransLocation)：商户名称(MerchantName)：

交易总额(TransAmount)：（如为多笔交易，请提供对账单复印件勾明具体交易）(Multipletransactions--Pleasemarkthetransactionamountonthecopyofthestatementrespectively)

查询类型(TransactionType)：

□消费(Consumption)□取现(CashWithdrawal)□转账(AccountTransfer)□利息及费用(InterestCommission)

查询交易币种(TransCurrency)：□人民币(RMB)□外币(ForeignCurrency)

查询内容(ChoiceofInquiry)：

1. □查询交易场所(TransactionLocation)/商户名称(MerchantName)：

□ATM交易(ATMTransaction)□POS交易(POSTransaction)□其他(Other)

2.□调阅单据，原因如下(TransactionReceiptRetrieval)

□记账金额与实际消费金额不符Theamountbilledisincorrect.TheTransactionAmountshouldbe____not_____.

□ATM未吐钞已记账ATMdoesnotdispense

□重复记账▁次Thechargelistedwasasingletransactionbutwasposted____timestomyaccount

□实际消费未成功，账户已被扣帐Transactionwasunsuccessful,buttheamounthavepostedtomyaccount

□存款未达帐，存款单附后Cashdepositdidnotposttomyaccount,enclosedacopyofthedepositreceipt

□退货交易未到帐，退货单据附后Creditdidnotposttomyaccount,Ihaveenclosedacopyofthecreditissued

□无法回想起交易情况，请调取交易单据供本人查验Ididnotrecognizethetransaction,pleaseprovidethecopyofthetransactionreceipt

□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）：NeitherI,noranyoneelseauthorizedbymeengagedinthistransaction.Mycreditcardisinmypossession,theaccountnumberwasusedfraudulently.

□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，本人已经尝试过与商户解决该问题。ThemerchantcontinuestochargemyaccountforperiodicbillingstomyaccountthatIcanceledon_____.Iwasspeakingwith______(ifknow)andhaveattemptedtoresolvethisdisputewiththemerchant.

□本人尝试与商户联系要求退还所购货物，但遭到商户拒绝。Iwanttoreturnthemerchandise,Ihavecontactedthemerchanttoresolvedthedisputeandthemerchantrefusedto:____