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附表1：牡牡牡丹丹丹卡卡卡账账账务务务查查查询询询申申申明明明书书书TransactionInquiryForm卡号(AcctNo)：卡片有效期(ExpDate)：交易日期(TransDate)：交易国家或地区(TransLocation)：中国商户名称(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(Interest&Commission)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2.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:_____Adjusttheprice_____Repairofreplacethegoodsorotherthingsofvalue_____Issueacredit.□该笔消费本人已经以其他方式付过款，付款凭证附后，本人已经尝试与商户解决该争议。Thechargelistedwaspaidpreviouslybyanothermethod.Iamenclosingproof.Ihavetriedtoresolvethiswiththemerchant.□本人已取消该预定，取消日期_____，取消号码______。Iamdisputingaguaranteedreservationservice.Dateofcancellation______,cancellationnumber______.□其他，请具体说明：AdditionalInformation:3.□利息及费用收取方式有误，要求调整(Interest&CommissionAdjustment)□利息(Interest)□取现费(CashwithdrawalFee)□滞纳金(OverdueFee)□超限费(OverLimitFee)□其他(Other)具体说明（对以上问题的详细描述）Pleaseprovidespecificexplanationabouttheaboveinquiry:本人陈述：上述情况属实，本人愿意承担由此产生的一切法律后果；若查明确为本人交易，本人愿意支付业务处理中所产生的费用。(Bycompletingthisform,youassertthattheinformationincludedisaccuratetothebestofyourknowledge.Ifyouadmittherequestedtransaction,itmeansthatyouauthorizedthebanktochargethecommissionforinquirytoyouraccount.)本人签名(Signature)：移动电话(MobilePhone)：固定电话(FixedPhone)：年月日(YY/MM/DD)适宜联络时间(AvailableContactTime)：重要提示：Importantalert:1、牡丹信用卡客户服务中心热线:95588，以上操作只收取本地话费。原件请您妥善保存，以备查询。1.ICBCCardCenterhotline:95588.Theaboveservicesonlychargeforthelocalphonecall.Theoriginalcopyshallbekeptproperlyforfurtherenquiries.2、调单收费标准：国内交易副本10元/份。国外交易副本5美元/份。2.Feeforretrievalrequest:10RMB/domestictransactioncopy.5USD/overseastransactioncopy.3、为了维护您的正当权益，请您在拒付期限内提出申请。您的调单或拒付申请日距该笔交易的交易清算日不能超过60天，超过此期限的申请恕无法受理。如您在当月10日前未收到上月对账单（上月无交易发生除外），请您及时与客户服务中心联系，要求补打账单，但调单或拒付期限仍按正常收到账单日计算。3.Tosafeguardyourrightsandinterests,pleasesubmitapplicationswithinthetermofchargeback.Theapplicationdateshouldnotbemorethan60dayslaterthanthesettlementdateofthetransaction.Theapplicationlaterthanthiscannotbeprocessed.Ifyouhavenotreceivedthebillingstatementofpreviousmonthbefore10thofthecurrentmonth,pleasecontactthecustomerservicecenterandaskforreprinting.However,thetimeframeofretrievalandchargebackiscalculatedasthebillingstatementhasbeenreceivednormally.4、为使您得到及时的服务，请您务必按照上述格式填写，确保内容真实、准确、完整。4.Inordertoenjoyin-timeservices,pleasefillinauthentic,accurateandcompleteinformationasspecified.5、银行在收到您的调单或拒付申请后与您确认，并将尽快向您通知调单或拒付情况，如您未得到回复，请及时与牡丹卡客服中心联系。5.Afterreceivingtheapplicationforretrievalorchargeback,thebankwillconfirmwithyouandinformyouabouttheresultsASAP.Incaseofnoreply,pleasecontactICBCCardCenterintime.6、请您按照对账单通知的还款金额及时还款，以免影响您的信用记录。如拒付成功，将对您的账户进行调整（另有说明的除外）。6.Pleaserepaytheamountspecifiedonthebillingstatementtokeepyourcreditrecordintact.Ifthechargebackisprocessedsuccessful,youraccountwillbeadjustedaccordingly(nototherwisespecified).7、如拒付申请中途撤销，调单费用不予退回7.Iftheapplicationforretrievalisrevokedintheprocess,theexpenseswillnotbereturened.附表2：Attachment2非非非本本本人人人交交交易易易附附附加加加说说说明明明SSSuuuppppppllleeemmmeeennntttaaarrryyySSStttaaattteeemmmeeennntttooonnnNNNooonnn---cccaaarrrdddhhhooollldddeeerrrTTTrrraaannnsssaaaccctttiiiooonnnsss中国工商银行：ICBC,本人所持卡号卡片有效期，现申明在（日期）（国家或地区）(商户名称)交易总额为的交易非本人交易，即交易非本人所为，本人拒绝支付上述款项，请予以调查处理。Mycardnumberis____________andthecardisvaliduntil_______.Iherebystatethatthetransactiondatedon________in________(countryorregion)with________(nameofmerchant)totaling________(volume)isnotmadebymyself.Itisanon-cardholdertransaction.Iherebyrefusetopayfortheabovementionedtransaction.Pleaseinvestigateandhandleit.交易发生时本人身处的国家（地区）为，城市为，未曾参与上述交易，对此本人愿意提供证据予以证明。Whenthetransactionwasmade,Iwasin______(city)of______(countryorregion)andwasnotinvolvedintheabovementionedtransaction.Iamwillingtoprovideevidencetoproveit.对具体情况的说明：Detailedexplanation:本人陈述：上述情况属实，本人愿意承担由此产生的一切法