SHOPPING INCENTIVE REFUND FORM / INCENTIVO DE

SHOPPING INCENTIVE REFUND FORM / INCENTIVO DE COMPRAS FORMATO DE REEMBOLSO
REQUEST DATE / FECHA DE SOLICITUD:
MONTH/MES
DAY/DÍA
FOLIO:
YEAR/AÑO
The acceptance of the refund is subject to due compliance with the requirements
set out in the "Resolución Miscelánea Fiscal". Also the acceptance is subject to that
the applicant presents itself with the dealership.
AGENCY NAME /NOMBRE DE LA AGENCIA:
La procedencia de la devolución está sujeta al debido cumplimiento de los requisitos
previstos en la Resolución Miscelánea Fiscal y que el solicitante de la devolución se
presente ante la concesionaria.
TRAVEL AGENT NAME/
NOMBRE DEL AGENTE DE VIAJES:
AGENT EMAIL/CORREO ELECTRÓNICO:
TOURIST DETAILS / DATOS DEL TURISTA
REFUND / REEMBOLSO
Name / Nombre:
ADAMANT CORPORATION, S.A. DE C.V.
Last Name / Apellido:
Credit Card / Tarjeta de Crédito
Cordillera de los Andes 240
Lomas de Chapultepec, C.P 11000
México D.F.
Email/ Correo electrónico:
Bank Name / Nombre del Banco
CONTACT/CONTACTO
Phone / Teléfono:
01800.00.NOTAX
+ 52 (55) 52 02 62 62
+ 52 (55) 55 20 07 96
Email/ Correo electrónico:
Card / Tarjeta
Home Adress / Dirección Particular:
Email:
info@moneyback.mx
www.moneyback.mx
City & Postal Code/ Ciudad & Código Postal:
Passport Num. / No. de Pasaporte:
State & Country / Estado & País:
Issuing country / País emisor:
Telephone number/ Número telefónico:
Date of departure / Fecha de salida del país:
I agree with the conditions on the reverse / Estoy de acuerdo con las condiciones del reverso.
Air or Cruise Line (name and number) / Línea Aérea o Embarcación (nombre y número):
Customer´s signature / Firma turista
Make sure you have available the following documents when presenting this Reimbursement Form: Passport, copy of your Immigration Form (FMT and / or cruise ID), Invoices, Vouchers, Boarding Pass, Credit Card Number
where the reimbursement will be made.
Asegúrate de llevar contigo los siguientes documentos al presentar este formato de devolución: Pasaporte, copia de la Forma Migratoria (FMT y / ó ID Crucero), Factura, Vouchers, Pase de abordar y Número de Tarjeta de Crédito.
GENERAL CONDITIONS
General conditions regarding shopping incentive return between Adamant Corporation, S.A. de C.V. (Moneyback) and the applicant (Foreign
Tourist).
Adamant Corporation, S.A. de C.V., hereafter Moneyback is a license of the Mexican Government under number SAT.AGRS.CONCECESION.002/07-005 to administer the Shopping Incentive Return to Foreign Tourists to whom it has been transferred in merchandise purchases, and
are leaving the country by air or sea.
The applicant hereby declares that he/she has the Foreign Tourist migratory status, in compliance with the General Population Law (Ley General
de Población), abiding all rules and regulations established by government law; that the data settled in the back of the present General
Conditions is true; and understands that the handling of the application depends on its truthfulness.
According to the foregoing Moneyback will refund the payment made for shopping incentive regarding merchandise detailed in the back, as long
as:
• The merchandise is purchased in an establishment which is a Moneyback affiliate, which extends an invoice and a copy of the voucher, when
applicable.
• The amount of the purchase made electronically with Foreign Credit Cards is of at least $ 1,200 Mexican Pesos per establishment, and when in
cash, does not exceed the amount of $ 3,000 Mexican Pesos per tourist.
• The documentation exhibited by the applicant will be revised and validated by Moneyback personnel, which will keep a copy of it, in COMPLETE
CONFIDENTIALITY.
• Equally, the Foreign Tourist accept and authorizes Moneyback personnel to physically review and validate the merchandise detailed on the back
of this document and, if necessary guard its departure from Mexican Territory.
• The Foreign Tourist hereby states that the merchandise for which the refund is request is in the process of leaving Mexican Territory, and has the
legal obligation of taking it along, not to incur is smuggling.
• The Foreign Tourist agrees that the Shopping Incentive Refund in the event that it is agreed upon electronic media, will be transferred on by
Moneyback in at most 45 natural days since the date of the reception of the application; said refund will be deposited to the electronic account
determinate by the applicant, releasing Moneyback of any responsibility of any delay or wrongfulness if the provided information is wrong or
false.
• All actions related here will be governed by Mexican laws, and only Mexico City’s courts of law will be competent regarding this these actions,
surrendering any other jurisdiction or country of origin’s laws.