Part 1. Personal information:
*Your name: *Your address: Your phone number: *Your email address:
Part 2. Information about your trip:
*Airline: *Your six-digit confirmation code or your e-ticket number: *Flight number: From: To: *Scheduled date of departure: *Was your flight delayed? yesno If yes, then by how much? (Please note: To be eligible for compensation, you must have arrived at least 3 HOURS later than scheduled to your final destination.) *Was your flight canceled? yesno If yes, then how many days in advance were you notified of the cancellation? (Please note: To be eligible for compensation, you must have been notified less than 14 DAYS before your scheduled departure.) If you ended up taking a replacement flight, please enter that flight number and date here. *Were you denied boarding? yesno Was there any reason given for the delay or cancellation? If yes, then what was the reason?
Part 3. Other information
*Did you have a connecting flight? yesno If yes, please include the flight number and scheduled date/time here. *Were you traveling with family members under the same reservation whom you want to include in the compensation claim? yesno If yes, please write the names of any adults here: If yes, please write the names of any children here:
*Have you already filed a complaint with the airline or received compensation? yesno
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