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1、龍卡信用卡疑義交易聲明（Declaration）卡號(hào)CARDNO:4895920307901594姓名ACCNAME：余弦YUXIAN交易日期TRANS.DATE商戶名稱MERCHANTNAME金額TRANSAMOUNT2014-01-04WWWHUGZBABYIERATHCOOLEEUR183.08本人對(duì)上述交易做出以下投訴Idisputetheabovetransaction(s)forthefollowingreason(s)。Pleaseinvestigatethematter:1、本人并無授權(quán)過上述交易。Ihaveneitherauthorizednorparticipate
2、dinthesetransactions.2、重復(fù)收款。Iwaschargedtwice.3、交易金額不符，正確應(yīng)為。Amountshouldbe4、本人曾于上述商戶簽購筆交易金額，但并未簽購過上述交易，且本人的信用卡從未遺失。Isignedintransactionsforatthenamedmerchant，butIdidn’tsignintheabovetransaction(s)andmycardwasinmypossession.5、本人確曾向上述酒店定房，但本人已于(日期，時(shí)間)向酒店取消定房并取得一取消號(hào)碼。Imadearoomreservationwithhotelan
3、dcanceleditat(AM/PM)on(date)。IwasgiventhecancellationNo.6、本人收到商戶簽發(fā)的退款單，但該款至今仍未記入本人賬戶。Ireceivedacreditslipfromthemerchantbutthecreditdoesn’tappearinmystatement.7、本人已用其他方式付款（）現(xiàn)金、（）支票、（）其他信用卡。（請(qǐng)附收據(jù)副本）。Ipaidthetransactionby()cash、()check、()othercreditcard.(Pleaseenclosethepaymentreceiptcopy).8、上述商戶無
4、法或不愿向本人提供有關(guān)交易的服務(wù)（請(qǐng)于備注欄內(nèi)詳細(xì)說明及附有關(guān)文件）。Themerchantwasunableorunwillingtoprovidetheservicesrequested.(pleaseexplainthedetailsintheCommentsSectionandenclosesupportingdocument).9、本人已于(日期)書面向上述商戶提出取消自動(dòng)轉(zhuǎn)賬授權(quán)，但該商戶未按照辦理（請(qǐng)附文件副本）。Iinformedthemerchanttocancelmymonthly/yearlyagreementbywritingon(date)(pleaseenc
5、losedocumentcopy).Nevertheless,myaccountstillbilled.10、本人未曾收到在以上商戶訂購的貨物。Ididn’treceivetheorderedmerchandiseattheagreed-uponlocationorbytheagreed-upondeliverydate.11、本人在ATM提款時(shí)，未成功（）；或金額有誤（），實(shí)際取現(xiàn)金額為。Ididn’treceivethecash(),orjustreceivedapartialamountwhichwas.12、其他。Others:備注Comments:.(請(qǐng)用英文填寫，如有必要可
6、另附頁。PleasewriteinEnglish.Youmayattachadditionalsheetsifnecessary.)本人聲明以上所言一切屬實(shí)，如有不實(shí)，愿負(fù)一切法律責(zé)任。并同意承擔(dān)因查詢而引發(fā)的相關(guān)查詢費(fèi)用。（普通商戶單據(jù)調(diào)閱費(fèi)USD5.00或RMB10.00）IunderstandtheCHINACONSTRUCTIONBANKinvestigatesallegedfraudulentorunauthorizedpre-paidcardusageandmayreferthesametotheappropriatelawenforcementagency.Iagreet
7、ocooperateinanyprosecutionofindividualsofmyknowledge，thestatementscontainedherebyaretrueandcorrectinallrespects。Iagreetodisbursetheretrievalrequestfeeintheinvestigationperiod(USD5.00foreverymerchantsorRMB10.00)簽署Signature:日期
