Passenger Property Claim

File Reference #
Record Locator (AA****)*
Type of claim*

Passenger Information

Last name*
First name*
Contact number*
Email address*
Mailing address*
City*
State*
Zip code*

Full Flight Itinerary

Flight #1

Flight number*
Date*
Origin
Destination

Flight #2

Flight number*
Date*
Origin
Destination

Flight #3

Flight number*
Date*
Origin
Destination

Number of ticketed passengers traveling in your party
Number of bags being claimed as missing/damaged
Number of passengers claiming missing/damaged baggage
Length of stay

Did you declare and pay for excess value at check-in?

Excess value

Was airline notified immediately?

Which location

Agent name

Was the loss reported to local law enforcement?

Local law enforcement agency

Local law enforcement contact name

Local law enforcement case number

*Certification and Understanding APPLICABLE IN USA ONLY. It is expressly understood and agreed by the claimant that the furnishing of this form and any assistance given by employees of Boutique Air are acts of courtesy and shall not constitute a waiver of any rights or an admission of liability by or on the part of Boutique Air, its employees or agents. Any other information and/or documents relating to this statement which are required by Boutique Air will be furnished by claimant upon request and shall be considered part of this statement.

Number of bags checked
Number of bags received
Location where bags were checked

Bag details

Type*
Material*
Color*
Brand*
Dimension*
Has a zipper?
Has wheels?
Has a retractable handle?
Purchased on*
Cost
Bag description (please note any luggage tags, ribbons, special markings):*

Content

Quantity
Name*
Size
Gender
Description
Store purchased
Purchased on
Original cost

Quantity
Name*
Size
Gender
Description
Store purchased
Purchased on
Original cost

Quantity
Name*
Size
Gender
Description
Store purchased
Purchased on
Original cost

Quantity
Name*
Size
Gender
Description
Store purchased
Purchased on
Original cost

Quantity
Name*
Size
Gender
Description
Store purchased
Purchased on
Original cost

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Passenger Statement

I do hereby warrant the foregoing statement and those on accompanying forms to be accurate, complete and true. I hereby make a claim against Boutique Air for the following details:

Total cost
Occurred on*

Passenger Property Claim

Passenger Statement

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