Claim form

What can we do for you?

ARE YOU OUR CLIENT?

YES and I suspect account or card misuse

YES and I need help with online, smart banking

YES and I have a question / need advice

YES and I want to make a complaint

Please contact our Infoline at +420 221 210 031.

WHAT AREA CAN WE ASSIST YOU WITH?

WHAT PRODUCT IS YOUR COMPLAINT ABOUT?

ATM

WHAT AREA CAN WE ASSIST YOU WITH?

Payment reference number

Amount

Currency (In case of domestic payment, choose CZK)

Date of payment

Payment time

Account number of the recipient/payer

Bank code of the recipient/payer

ATTACHMENT - HOLDER'S STATEMENT ON THE DISPUTED TRANSACTION

If you are complaining about a transaction, please attach a completed Cardholder Statement on Disputed Transaction form (PDF, 1MB).

ATTACHMENT - HOLDER'S STATEMENT ON THE DISPUTED TRANSACTION

If you are claiming a Refund Request, please attach the completed Refund Request for Incorrectly Sent Funds form (PDF).

Please contact our Infoline at +420 221 210 031.

Name

Surname / Company name

Date of birth

E-mail

Mobile phone

Account / card number (last 6 digits)

Please describe your claim/complaint here, provide as much detail as possible so that we can resolve your complaint as soon as possible.

By continuing, I take note of the information about the processing of personal data.