NEONISM EVO e-Wallet Customer Service CUSTOMER CLAIM FORM This form supports Customer Claim Procedure. You will be 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.