NEONISM EVO e-Wallet Customer Service CUSTOMER CLAIM FORM This form supports Customer Claim Procedure. Every claim must be resolved and the customer notified of the outcome within 15 calendar days of receipt. Complete all white fields; tick the relevant boxes. A. Customer / Claimant Information Customer full name EVO Registered phone no. E-mail B. Claim Details Category (tick one): Billing & feesTransaction dispute (top-up / withdrawal / send / receive / QR / NFC)Card (Visa virtual / physical)Bill payment / e-voucher / e-SIMAccount access & KYC (OTP / passcode / hold / deletion)Data privacyService quality / conductFraud / unauthorized activity (refer to Compliance)Other Other: Transaction ID Transaction date Amount Currency (USD / LBP) —Please choose an option—USDLBP Description of claim I confirm that the information provided is complete and accurate.