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Personal Information
*Title: *First Name:
Second Name *Last Name:
Alfursan Membership No. Profession
Nationality Zip Code
*City P.O.Box
*email Fax
*Phone (Country code + City code + Phone number). *Mobile  (Country code + Mobile number)
Mailing Adress  
Did any other person travel with you? Yes No
Provide name on baggage (If different from yours) or any external ID.
*Ticket Number.
Flight Itinerary
From To Date FlightNo Class AirLine  
Claim Information
Claim Type:
*Station: *Claim No:
Total number of pieces & weight of mishandled baggage Pieces  
Pieces Weight Kg
Did you pay excess baggage charges? Yes No
*Total number of pieces checked:  
Baggage was last seen complete and in good condition at  
List and Details of Lost / Damaged pieces
Details of Lost / Damaged Piece
Cost + Currency* Brand
Baggage Type* Material*
Color* Made in
Date of Purchase Combo Lock No.
Zipper Yes No
Wheels Yes No
List of lost / Damaged Items Inside This Piece
Items Brand Quantity Purchase Date Purchase at (Shop/City) Currency Cost  
Please provide purchase receipts/invoices to substantiate your claim
Please add total
Report upon arrival Yes No
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I hereby declare that this information is true & complete. Acceptance of this form is not an acknowledgment of liability.
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