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Transaction Enquiry For the investigation of NPP/Direct Entry/BPay Transactions A. Membership Details Title
(PLEASE PRINT IN BLOCK LETTERS)
Given Name(s)
Surname
Address
Membership Number
B. Osko/NPP/Direct Entry Recall Dispute Details
(PLEASE PRINT IN BLOCK LETTERS)
I acknowledge the transaction was authorised. However the BSB, Account or PayID details are incorrect. I am seeking a recall of funds. Note: It may not always be possible to recover a payment paid to an unintended recipient. Transaction Date Incorrect BSB No. Incorrect Account No. Incorrect Account Name Incorrect PayID details Amount
Correct BSB No.
Correct Account No.
Correct Account Name
Correct PayID
I acknowledge the transaction was authorised. However the intended recipient is claiming funds have not been received. I am seeking a recall of funds. Transaction Date Amount BSB Account Number Account Name details I agree to pay the dispute fee of $25.00
PayID
C. Osko/NPP/Direct Entry Trace Dispute Details
(PLEASE PRINT IN BLOCK LETTERS)
I acknowledge the transaction was authorised. However the BSB, Account or PayID details are incorrect. I am seeking a final destination of funds. Note: It may not always be possible to recover a payment paid to an unintended recipient. Transaction details
Date
Incorrect BSB No.
Incorrect Account No.
Incorrect Account Name
Incorrect PayID
Amount
Correct BSB No.
Correct Account No.
Correct Account Name
Correct PayID
I acknowledge the transaction was authorised. However the intended recipient is claiming funds have not been received. I am seeking a trace on this transaction. Transaction details
Date
Amount
BSB
I agree to pay the dispute fee of $25.00
Account Number
PayID
D. BPay Details for Investigation Biller Name
Account Name
(PLEASE PRINT IN BLOCK LETTERS)
Biller Code
Customer Reference Number
Date Payment Due Receipt Number
Payment not received by Biller Payment made to wrong Biller Payment made with wrong Customer Reference Number Incorrect CRN
Amount $ Payment duplicated
Correct CRN
Other (please provide details) I agree to pay the BPay dispute fee of $22.00 Bpay investigations are to be sent to the Finance Department.
Declaration I declare that the above information is true and correct. Signature
X
Signature Date
/
/
X
Date
/
/
Remote Access Use Only
Operator Name
Sydney Credit Union Limited ABN 93 087 650 726 AFSL 236 476
Date and time received
TE-RA-04/18
