Instructions
• Please keep a copy of this completed form and original documentation.
• The signed form must be sent by mail to the address indicated or emailed to arbitration@cba.com.au.
• If acknowledgement of your request is not received within 10 business days, please call Travel Money on 1300 660 700.
To: 2067 Operations Processing Centre, Reconciliations and Disputes
PO Box 492, Lidcombe NSW 1825
Facsimile number: (02) 8737 3623
Travel Money ATM Shortpay Request for Investigation
Section 1 – Customer details
First name
Last name
Home address
State Postcode
Home telephone number
Business telephone number Mobile number
Customer email
Title Mr
Mrs Miss
Ms
Other
Section 2 – Card details (give details of card that initiated the transaction)
Travel Money Card number - Primary
Travel Money card number - Backup
Section 4 – To be completed by customer in their own words
(please print clearly if insufficient space attach a piece of paper with your additional information)
Give details about the problem (attach copies of any transaction receipts, give name and addresses of any witnesses)
I request the Bank to investigate this claim and declare that the details are true and correct to the best of my knowledge. I am
aware that the Bank may provide information to the police to assist in their investigation and resolution of the dispute.
✗
Customer’s signature
Time Date
Section 3 – Details of transaction(s) requiring investigation
Note:
(a) A copy of the receipt(s) (if available) are to be attached.
(b) A copy of the online transaction listing from www.commbank.com.au/travelmoney showing the transaction in dispute MUST be attached.
(c) An ATM Shortpay only occurs when all of the following apply:
• The cardholder states that they made the transaction requiring investigation
• The cardholder did not receive all or some of the cash requested
• The account has been debited
Date of
transaction
Amount of
withdrawal
Amount
received
Amount
shortpaid
Time of
transaction
Location/Details of ATM
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
CBA Other Bank ATM
Type of ATM (please tick (✔) appropriate box)
Commonwealth Bank of Australia
ABN 48 123 123 124
Australian credit licence 234945
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