MARIO BERNARDI MARIOBERNARDI54@YAHOO.

IT

Milano 08-01-2013 Ns. Rif. AD/2013/ 10!858 /18/0 / "a#$a n. 5255%%%%%%%%3 02 &a'(n)o s(*+i$o alla s+a s(*nala,ion( $(l(foni'a- l( 'onf(#.ia.o '/(- 'o.( 0#(1is$o )al R(*ola.(n$o Ti$ola#i- 0(# 0o$(# *(s$i#( la 0#a$i'a )o22ia.o n('(ssa#ia.(n$( #i'(1(#( +na 'on$(s$a,ion( s'#i$$a ( fi#.a$a- 'on $+$$a la )o'+.(n$a,ion( n('(ssa#ia. 3a 0#(*/ia.o 4+in)i )i 'o.0l($a#( il .o)+lo all(*a$o- )i fi#.a#lo ( )i in1ia#lo urgentemente 1ia 0os$a o fa5- 'on i )o'+.(n$i #i'/i(s$i- a6 CartaSi Spa - Ufficio Titolari Corso Sempione n. 55 20145 Milano MI (fax 02 !4""4#20$. %ualora non rice&essimo tale 'ocumenta(ione entro 15 giorni 'a oggi - non 0o$#(.o )a# 'o#so alla s+a ric)iesta 'i &erifica rim*orso- '/( sar+ ,uin'i annullata. In 4+(s$o 'asol(i 0o$#7 (1(n$+al.(n$( 0#(s(n$a#( +na n+o1a 'on$(s$a,ion( in forma scritta- )a fa# 0(#1(ni#( (n$#o 0 *io#ni )alla )a$a )i #i'(,ion( )(ll8(s$#a$$o 'on$o- 'o.0l($a )(lla )o'+.(n$a,ion( 0#(1is$a. -. ISC/ITT0 1I S-/2I3I SMS4 9( la s+a 'on$(s$a,ion( #i*+a#)a +na o 0i: $#ansa,ioni no$ifi'a$( 1ia 9M9- il #(la$i1o a''e*ito ; s$a$o annullato in attesa 'i una sua contesta(ione scritta . <+alo#a non 'i 0(#1(niss( il .o)+lo all(*a$o = 'o.0ila$o- fi#.a$o ( 'o.0l($o )(lla )o'+.(n$a,ion( #(la$i1a alla/( $#ansa,ion(/i 'on$(s$a$a/( - entro 15 giorni 'a oggi- sa#(.o 'os$#($$i a) a''e*itare i relati&i importi s+l s+o 0#i.o (s$#a$$o 'on$o +$il(. I .i*lio#i sal+$iAn$onio D8Aloia Di#($$o#( "a#$( )i >a*a.(n$o All.6 '.s. 5S6 ATTEN?IONE@ Il .o)+lo all(*a$o )(1( (ss(#( in1ia$o insi(.( alla )o'+.(n$a,ion( in)i'a$a- in ass(n,a )(lla 4+al( la 0#a$i'a non 0o$#7 (ss(#( *(s$i$a.

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Ns. Rif. AD/2013/ 10!858 /18/0 / "a#$a n. 5255%%%%%%%%3 02 6-TT-/1 7I C08T-ST13I08Claim form (Indemnity Letter) 0pera(ione non riconosciuta (Carta in possesso del Titolare, bloccata) Transaction not recognised (Card in possession, blocked)

Io so$$os'#i$$o MARIO BERNARDI )i'/ia#o )i (ss(#( s$a$o a))(2i$a$o )i +na o 0i: o0(#a,ioni4+i )i s(*+i$o in)i'a$(- '/( non sono s$a$( )a .( a+$o#i,,a$(. Di'/ia#o inol$#( )i non a1(# a+$o#i,,a$o $(#,( 0(#son( a) +$ili,,a#( la .ia 'a#$a )i '#()i$o. I MARIO B R!AR"I declare t#at I #a$e been debited %it# one or more transactions, listed belo%, t#at I #a$e not a&t#orised' I also declare t#at I #a$e not a&t#orised anybody to &se my credit card' 7ettaglio opera(ioni ( List of trasactions (barrare la casella corrispondente all)importo oggetto della contesta*ione)(tick t#e transactions t#at are not recognised) 09-01-201! 95#!9# -U/0 450.:2 ;067-8 -1;6- C0I8S 7escri(ione 'ella contesta(ione ( Claim description <61U/

Ho 'on$#olla$o $+$$( l( .i( #i'(1+$( ( non /o (1i)(n,a )i s0(s( )a .( (ff($$+a$( 0#(sso l8(s(#'i,io in 4+(s$ion(. I #a$e c#ecked my credit card receipts and do not #a$e any transactions for any amo&nt relating to t#is merc#ant t#at #a$e been debited or #a$e yet to be debited to my acco&nt' Di'/ia#o inol$#( '/( A2a##a#( la 'as(lla 'o##is0on)(n$(B6 I f&rt#er declare t#at (tick t#e appropriate bo+), o la 'a#$a )i '#()i$o (#a in .io 0oss(sso alla )a$a )(ll8o0(#a,ion( 'on$(s$a$a () ; an'o#a in .io 0oss(sso o**i. T#e card %as in my possession at t#e date of t#e disp&ted transaction and it is still in my possession o la 'a#$a )i '#()i$o (#a in .io 0oss(sso alla )a$a )(ll8o0(#a,ion( 'on$(s$a$a ( /o 0#o11()+$o a 2lo''a#la 0(# +$ili,,o f#a+)ol(n$o in )a$a6 CCCCCCCCCCCCCCCCCCCCCC CC

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T#e credit card %as in my possession at t#e date of t#e disp&ted transaction b&t %as s&bse-&ently blocked d&e to fra&d&lent &se on date, ...................... .. "onf(#.o inol$#( '/( / I also confirm t#at6 o Non /o .ai ins(#i$o il n+.(#o )(lla .ia 'a#$a )i '#()i$o n(l si$o in)i'a$o n(lla 'on$(s$a,ion( = I #a$e ne$er entered my credit card n&mber in t#e %ebsite stated in t#e claim' -&entuali commenti ( /&rt#er comments CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC -lenco 'ei 'ocumenti allegati= necessari alla gestione 'ella pratica ( List of attac#ed doc&ments, essential for t#e resol&tion of t#e matter All(*o i s(*+(n$i )o'+.(n$i a s+00o#$o )(ll( .i( )i'/ia#a,ioniA2a##a#( la 'as(lla 'o##is0on)(n$(B6 / I enclose t#e follo%ing doc&ments in s&pport of my declarations(tick as appropriate, o "o0ia )(lla )(n+n'ia )i +$ili,,o f#a+)ol(n$o )(lla .ia 'a#$a )i '#()i$o )a 0a#$( )i $(#,i all( A+$o#i$7 'o.0($(n$i. Copy of t#e report for fra&d&lent &se of my credit card from t#ird parties to t#e police' Non all(*o )o'+.(n$i 0(#'/D (da compilare solo se non si allegano doc&menti), I #a$e not incl&ded any doc&ments d&e to (complete only if t#ere are no doc&ments incl&ded), CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC Il so$$os'#i$$o- 'onsa0(1ol( )(ll( 'ons(*+(n,( 'i1ili ( 0(nali )i +na falsa )i'/ia#a,ion(*a#an$is'( so$$o la 0#o0#ia #(s0onsa2ili$7 '/( 4+an$o so0#a )i'/ia#a$o 'o##is0on)( a 1(#i$7 ( )i'/ia#a inol$#( )i non (ss(#( in 0oss(sso )i al$#( info#.a,ioni o )o'+.(n$i #(la$i1i allEo0(#a,ion( o**($$o )(lla 'on$(s$a,ion(. I f&lly &nderstand t#e ci$il and penal conse-&ences of a false declaration and I g&arantee

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&nder my f&ll responsibility t#at %#at I declared abo$e corresponds to t#e tr&t#' I f&rt#er declare t#at I am not in possession of any ot#er information or doc&mentation related to t#e disp&ted transaction' DATA "ate ------------------------&IRMA DE3 TITO3ARE Card#olders signat&re ---------------------------

No.( ( 'o*no.( / name and s&rname, R('a0i$i 0(# 'o.+ni'a,ioni )a "a#$a9i / contact details for comm&nications from Carta0i6 $(l(fono 'asa / #ome telep#one6 $(l(fono +ffi'io / office telep#one6 n+.(#o '(ll+la#( / mobile p#one6 in)i#i,,o (-.ail / email address6 3a 0#(*/ia.o )i 'o.0l($a#( 4+(s$o .o)+lo- )i fi#.a#lo ( )i #(s$i$+i#'(lo urgentemente al s(*+(n$( in)i#i,,o o fa5 ( %e kindly ask yo& to complete t#is form, sign it and send it immediately to t#e follo%ing address or fa+, CartaSi > Ufficio Titolari > Corso Sempione= n. 55 > 20145 Milano MI ?ax n. 02 !4"".4#20 8@A <+(s$o .o)+lo )(1( (ss(#( +$ili,,a$o sola.(n$( 0(# la 'on$(s$a,ion( in 'o#so. This form must only be used for the current disputed transaction'