Delta Baggage Claim Form

Property Loss Claim Form

5-1078 Rev 12.09

You will likely receive your luggage within 24 hours. In the unlikely event you do not, please contact the airport at which you filed the claim. If after 5 days, you still have not received your luggage, please fill out this form and submit it and all supporting documentation to:

Delta Air Lines, Inc. Customer Care Baggage, P.O. Box 20598 Atlanta, GA 30320-2598

Fax Number: (888) 880-3412

PLEASE DO NOT FILL OUT AND MAIL FORM UNTIL AFTER 5 DAYS HAVE ELAPSED WITHOUT YOUR LUGGAGE.

We are sorry your luggage was not available after your recent flight. Please accept our apology for the inconvenience this caused. Everything possible will be done to locate and return your property to you promptly. Successful tracing and resolution of this claim depends upon prompt completion and return of this form for each bag that is missing along with the following required documents:

• Passenger ticket receipt(s) for each person involved in this loss.
• Claim check(s) or claim check receipt for the missing property.
• Purchase receipt(s) or proof of ownership for all items valued at $250.00 (U.S.) or more.

Number of pieces checked Number missing Estimated weight of each missing piece

Where did you check your luggage Curbside Airport Counter Departure Gate Other

Was the bag checked under another name? Yes No If yes, what name?

Where did you last see your luggage?

Was Delta notified of loss immediately? Yes No If yes, which office?

Date Time In Person By Telephone

Was loss reported to any other airlines? Yes No If yes, which airline?

If loss not reported immediately, explain reason for delay

Did you see your luggage in customs? Yes No If no, did you file a claim then? Yes No With Whom?

Was excess valuation purchased at time of check-in? Yes No If yes, include copy of receipt.

Were you charged for extra pieces/excess weight at time of check-in? Yes No If yes, include copy of receipt.

YOUR COMPLETE ITINERARY

DESCRIPTION OF LUGGAGE

(Continued On Next Page)

ADDITIONAL COMMENTS

List name of other persons or companies which may be on documents, papers, etc. Also any initials which may appear on personalized toiletry kits, monogrammed shirts, etc.

Have you or a member of your family or household ever had a previous baggage property loss or claim with Delta Air Lines or any other airline? Yes No

If yes, please provide airline(s), name(s), and date(s).

It is expressly understood and agreed that the furnishing of this proof of loss form by Delta Air Lines, Inc., or assistance in making of the proof of loss is not a waiver of any rights or admission of liability by said Company and any other information and other documents required by said Company shall be furnished on request and considered a part of these proofs. The acceptance of this document shall not be deemed to be a waiver of any defenses of the Company.

The Claimant expressly understands and agrees that he/she is required to immediately inform Delta Air Lines in writing, in the event all or part of the property which is subject matter of this claim is delivered to Claimant from a source other than Delta, its agents, or employees.

The United States Post Office Department has investigative jurisdiction under federal laws relating to sending false or fraudulent claims through United States mails, any such claims received by Delta Air Lines are reported to the United States postal authorities. Loss of luggage involving interstate shipment or articles from such luggage due to theft come within the purview of federal statues and, therefore, are subject to investigation by the Federal Bureau of Investigation.

I do hereby warrant this statement and those on the accompanying form(s) to be accurate, complete and true, and, I hereby make a claim against Delta Air Lines in the amount of $ for the loss occurring on 20

Please be assured that if your property is located, you will be contacted promptly. Should we be unable to locate your property, please allow 6-8 weeks from mailing date for processing.

Delta is not liable for loss of money, jewelry, computer/computer equipment, cameras, VCR’s, electronic/video or photographic equipment, negotiable papers or securities, heirlooms, antiques, artifacts, works of art, silverware, irreplaceable books or publications/manuscripts/business documents, precious metals, and other similar valuables or commercial effects. Please note that itineraries traveled internationally are governed by the Montreal Convention and are not subject to the domestic tariff.

RETAIN A COPY OF ALL DOCUMENTS (e.g., CLAIM FORM AND RECEIPTS). MAIL THE ORIGINAL DOCUMENTS WITHIN 21 DAYS FROM THE DATE OF LOSS TO THE ADDRESS AT THE TOP OF THE FIRST PAGE.

DESCRIPTION OF CONTENTS

*Gender: M=Male, F=Female, MC=Male Child, FC=Female Child Age of Child:

If additional space is needed, please attach separate paper with same data as above. Total Value of Bag & Contents