Online Dispute Resolution Form

{"fields":[{"key":"disputeFormModel","wrapper":"panel","templateOptions":{"label":"DisputeInformationModel.disputeFormModel"},"fieldGroup":[{"key":"odrTransactionType","type":"select","templateOptions":{"label":"DisputeFormModel.odrTransactionType","defaultValue":"Please Select","options":[{"name":"Card Transaction Point of Sale (PoS)","value":"Card Transaction Point of Sale (PoS)"},{"name":"Card Not Present (CNP) (e-commerce)","value":"Card Not Present (CNP) (e-commerce)"},{"name":"Automated Teller Machines (ATMs)","value":"Automated Teller Machines (ATMs)"}],"required":true},"validation":{"required":"Errors.odrTransactionType.required"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.odrTransactionType\" | translate"}},{"key":"name","type":"input","templateOptions":{"label":"DisputeFormModel.name","type":"text","pattern":"^[A-Za-z. ]+$","required":true},"validation":{"required":"Errors.name.required","pattern":"Errors.name.pattern"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.name\" | translate"}},{"key":"email","type":"input","templateOptions":{"label":"DisputeFormModel.email","type":"text","pattern":"^[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\\.[A-Za-z]{2,4}$","required":true,"tooltip":"Tooltip.email"},"validation":{"required":"Errors.email.required","pattern":"Errors.email.pattern"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.email\" | translate"}},{"key":"confirmEmail","type":"input","templateOptions":{"label":"DisputeFormModel.confirmEmail","type":"text","pattern":"^[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\\.[A-Za-z]{2,4}$"},"validation":{"pattern":"Errors.confirmEmail.pattern"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.confirmEmail\" | translate"}},{"key":"issuer","type":"select","templateOptions":{"label":"DisputeFormModel.issuer","defaultValue":"Please Select","options":[{"name":"ICICI Bank Limited","value":"115"},{"name":"SBI Cards and Payment Services Limited","value":"596"},{"name":"IndusInd Bank","value":"582"},{"name":"American Express Banking Corp.","value":"460"},{"name":"Axis Bank","value":"662"}],"required":true},"validation":{"required":"Errors.issuer.required"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.issuer\" | translate"}},{"key":"transactionAmount","type":"input","templateOptions":{"label":"DisputeFormModel.transactionAmount","type":"text","pattern":"(\\d{1,9}(\\.\\d{1,2})?)","required":true},"validation":{"required":"Errors.transactionAmount.required","pattern":"Errors.transactionAmount.pattern"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.transactionAmount\" | translate"}},{"key":"transactionDate","type":"inputDate","templateOptions":{"label":"DisputeFormModel.transactionDate","type":"date","required":true,"tooltip":"Tooltip.transactionDate"},"validation":{"required":"Errors.transactionDate.required"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.transactionDate\" | translate"}},{"key":"merchantName","type":"input","templateOptions":{"label":"DisputeFormModel.merchantName","type":"text","required":true},"validation":{"required":"Errors.merchantName.required"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.merchantName\" | translate"}},{"key":"cardNumber","type":"input","templateOptions":{"label":"DisputeFormModel.cardNumber","type":"text","pattern":"(^\\d+$)","required":true,"minlength":5,"maxlength":5},"validation":{"required":"Errors.cardNumber.required","pattern":"Errors.cardNumber.pattern","minlength":"Errors.cardNumber.minlength","maxlength":"Errors.cardNumber.maxlength"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.cardNumber\" | translate"}},{"key":"comments","type":"textarea","templateOptions":{"label":"DisputeFormModel.comments"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.comments\" | translate"}},{"key":"captchaImg","type":"captcha","templateOptions":{"label":"DisputeFormModel.captchaImg","type":"text","defaultValue":"XfavqZ"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.captchaImg\" | translate"}},{"key":"captcha","type":"input","templateOptions":{"label":"DisputeFormModel.captcha","type":"text","required":true},"validation":{"required":"Errors.captcha.required"},"expressionProperties":{"templateOptions.label":"\"DisputeFormModel.captcha\" | translate"}}]}]}

J6oZh7Aj1bXTi8XA5HEs