Your First name/Last name

Address

Postal code/ CITY

[Name of your bank]

Address

Postal code/ City

Done in [your city], on [specify the date].

Subject: Dispute regarding a double direct debit

Madam, Sir,

I hold a deposit account with your institution, number [indicate your account number]. I have received my bank statement for the month of [indicate the month of the statement]. I have noticed an obvious error: a direct debit appears twice on the same date and for the same amount.

Consequently, I kindly request that you reimburse me the amount of [indicate the amount to be refunded] as soon as possible.

While awaiting your reply, please accept, Madam, Sir, the expression of my best regards.

[Your signature]