Have you, or any member of your household, had a previous baggage claim with AA or any other airline in the last 5 years?
If yes, list each airline, claimant name and dates (attach an additional page if necessary)
Information gathered on this form may be shared with other airlines, local, state and federal law enforcement agencies or private insurers.
PASSENGER PROPERTY QUESTIONNAIRE
AAdvantage: File Reference Number:
Type of Claim: (check all that apply)
Damaged Luggage and/or Contents
Mr. First Middle Last Name
Permanent Mailing Number Street Apt.
Temporary Mailing Number Street Apt.
Email Address: Employed by:
Your Complete Flight Itinerary
From To Airline Flight Number Travel Date
Number of ticketed passengers
traveling in your party:
Number of passengers
claiming missing baggage:
Purpose of trip? Length of stay?
Were you charged for excess
and/or overweight baggage:
Did you declare and pay for excess value: Yes
Value declared: $
Have you received your baggage: Yes
If Yes, when was your bag received M/D/Y?
Was airline notified of loss immediately? Yes
If yes, at what office? By telephone
If airline was not notified within 4 hours, state the reason for the delay:
Where and when did you last see your baggage?
Has this loss been reported to another airline and/or insurance company? Yes
If yes, please provide name of airline and city where reported and/or insurance company and phone 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
American Airlines, Inc., are acts of courtesy and shall not constitute a waiver of any rights or an admission of liability by or on the part of American Airlines, Inc., its
employees or agents. Any other information and/or documents relating to this statement which are required by American Airlines, Inc., will be furnished by claimant
upon request and shall be considered part of this statement.
e United States Post Office has investigative jurisdiction under federal laws relating to sending false or fraudulent claims through the United States mail and any
such claims received by American Airlines, Inc., are reported to the United States Postal Authorities. Loss of baggage in interstate shipment or of articles from such
baggage come within the purview of federal statutes relating to thefts from interstate shipment and, are therefore, subject to investigation by the Federal Bureau of
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