Bank of Maharashtra Form for ATM related complaints Form Download

The attached document is a bilingual (Hindi and English) “Form for ATM related complaints” designed by the Bank of Maharashtra. It serves as a structured dispute application for customers facing operational errors with their debit or ATM cards. [1]

The key points of the form are broken down into its three primary sections:

This initial section captures where the complaint should be routed and details who is filing it:

• Routing Details: The form is addressed directly to the Branch Manager and requires the customer to fill in the Name of Bank, the specific Branch, and the City.
• Customer Information: Under subsection 1, the cardholder must explicitly state their full Name, their Account Number, and their associated Debit Card / ATM Card Number.

Subsection 2 isolates the physical machine responsible for the failed transaction to allow the bank to trace its electronic journal prints (JP logs): [2]

• ATM ID / Location: Captures the unique automated identification code of the kiosk. If the numeric ID is missing, the customer must write down the exact physical location/address of the ATM.
• Name of the ATM Bank: Indicates whether the transaction occurred on a Bank of Maharashtra machine or a cross-bank network (third-party/other bank ATM).

Subsection 3 outlines the explicit operational nature of the customer’s grievance:

• Cash Withdrawal Failures:
  • The precise Amount requested for withdrawal versus the Amount actually disbursed by the machine.
  • The exact Amount debited from the bank account balance.
  • The Date (mm/dd/yy) and precise Time of the transaction.
• Card Captured: A dedicated checkbox if the ATM physically swallowed or retained the debit card without returning it.
• Other Complaints: Open space provided for any adjacent errors not covered by cash or card retention.

To validate the legal request, the form requires the Signature of the Card Holder, an active Contact/Mobile Number, and the formal Date of submission. A footnote specifies that this must be submitted to the base branch where the account linked to the card is actually maintained.

While filling out this form, keep in mind these automatic consumer protection rights mandated by the Reserve Bank of India (RBI):

• Auto-Reversal Timeline: Banks are required to reverse failed ATM cash-withdrawal debits within T+5 working days (where T is the transaction day). [2, 3]
• Delay Compensation: If the bank fails to credit your account back within 5 working days, they are legally required to pay you ₹100 per calendar day of delay, which should be auto-credited to your account. [2, 4]

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