Dear American Airlines/US Airways Customer,
Please accept our sincere apology for the mishandling of your property. We understand your concern and realize the inconvenience this causes. Once the form has been returned to us, we will intensify our tracing efforts with the goal of locating and returning your property.
Complete all areas of this form and return it to us no later than 45 days from the date of travel. Failure to return this completed form to us within the timeframe may result in the denial of your claim.
If your claim involves more than one piece of baggage, please itemize each bag and its contents separately. Failure to include the requested information may affect the processing of your claim.
Check list:
Airline ticket receipts
Baggage claim checks
Receipt(s) for excess value claimed
Receipt(s) for excess baggage charges paid
Receipt(s) for all items valued over $150.00
Clear and legible government issued photo identiication for each passenger making a claim
Damage claims: retain all damaged bags and/or contents until your claim has been resolved
Retain a copy of all documents submitted to the airline for your personal records
Once you have completed the form, please return it to us by mail or fax:
American Airlines, Inc. |
US Airways |
Central Baggage Service |
Central Baggage |
PO Box 619613 – MD 1322 |
4000 E Sky Harbor Blvd. |
Dallas/Ft. Worth, TX 75261-9613 |
Phoenix, AZ 85034 |
Fax: 972-425-0714 |
Fax 480-693-2305 |
Email: PPQ1600@aa.com |
Email: Baggage.Resolution@usairways.com |
Liability Limitations:
Liability for loss, delay, or damage to baggage will be limited as follows:
Domestic Travel (wholly within the United States) - $3,400 per ticketed passenger.
Certain items are excluded from liability; see Contract of Carriage at AmericanAirlines.com or USAirways.com
International Travel (including domestic portions of international itineraries) are covered by the Montreal Convention – 1,131 SDRs
(Special Drawing Rights) per ticketed passenger
Thank you for your cooperation,
Your American Airlines Central Baggage Team
PASSENGER PROPERTY QUESTIONNAIRE
AAdvantage or US Dividend Account: ________________ |
Record Locator or File Reference Number: ________________ |
Type of Claim: (check all that apply)
Lost Luggage |
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Missing Contents |
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Damaged Luggage and/or Contents |
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Delay Expenses |
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Mr. First |
Middle |
Last Name |
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Phone Number |
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Mrs. |
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Ms. |
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Home: |
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Business: |
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Permanent Mailing |
Number |
Street |
Apt. |
Temporary Mailing |
Number |
Street |
Apt. |
Address |
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Address |
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City |
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State |
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City |
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State |
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Zip Code |
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Zip Code |
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Country |
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Country |
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Postal Code |
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Postal Code |
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Email Address: |
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Employed by: |
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Occupation: |
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Your Complete Flight Itinerary
Have you, or any member of your household, had a previous baggage claim with AA/US or any other airline in the last 5 Years? Yes |
No |
If yes, list each airline, claimant name and dates (attach an additional page if necessary) |
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Airline(s) __________________________________________________ Name(s) __________________________________________________
Date(s) _______________________________________________________________________________________________________________
Information gathered on this form may be shared with other airlines, local, state and federal law enforcement agencies or private insurers.
Number of ticketed passengers |
Number of passengers |
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Purpose of trip? |
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Length of stay? |
traveling in your party: |
claiming missing baggage: |
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Were you charged for excess |
Yes No |
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Did you declare and pay for excess value: Yes |
No |
and/or overweight baggage: |
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Value declared: $ |
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Have you received your baggage and are you missing contents only: |
Yes No |
If yes, how many bags are missing contents? |
Was airline notiied of loss immediately? Yes No |
If yes, at what ofice? |
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By telephone |
In person |
If airline was not notiied 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? Yes No |
If yes, please provide name of airline and city where reported. |
Certiication 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.
The United States Post Ofice 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
Investigation.
OP124 (Rev 11/2013) CPN 5689520 |
Complete Reverse Side |
BAGGAGE AND CONTENT DESCRIPTION
NOTE: When more than one piece of baggage is lost, complete a separate baggage and content list for each missing bag.
Baggage routing: |
Flight number(s) on claim check: |
Airport checked from: |
Airport checked to: |
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Baggage tag number(s): |
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Passenger ticket number(s): |
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Number of bags checked: |
Number of bags received: |
Baggage checked at: Curbside Ticket Counter Gate Other |
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Was baggage rechecked and new tags issued? Yes |
No |
If yes, at what airport? |
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Was baggage available at Customs? Yes |
No |
N/A |
If yes, at what city? |
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Give details if the original routing was changed after starting your trip: |
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Was your property packed in a box? Yes |
No |
Was your property packed with an external cover? (example: golf bag) Yes No |
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Is the name on the bag(s) different from the passenger? If so, what name? |
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Please list any initials, marks, tags, ribbons, cords, tape or other exterior markings on your bag(s): |
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Bag Type |
Material |
Color(s) |
Brand |
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Bag |
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Open/Close |
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Wheels |
Retractable |
Purchase |
Cost of Bag |
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Dimensions |
with Zipper |
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Handle |
Date |
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Hard |
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Yes |
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Yes |
Yes |
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Soft |
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No |
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No |
No |
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Gender = M: Male F: Female |
CH: Child |
I: Infant (under 2 yrs) |
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Gender |
Description |
Color |
Material |
Brand Label |
M,F,CH,I |
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Shoes |
12 |
M |
White with blue stripes |
Leather |
Nike |
Sears |
Jan-13 |
$55.00 |
T-Shirts |
L |
M |
Undershirts |
White |
Cotton |
Hanes |
JCP |
Jan-13 |
$20.00 |
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If additional space is needed, please attach a separate page. Be sure to include a complete description and cost for each item along with receipts for all items valued over $150.00.
I do hereby warrant the foregoing statement and those on the accompanying forms to be accurate, complete and true. I hereby make a claim against American Airlines, Inc./US Airways, in the amount of $ ______ for a loss occurring on _______________
______________________________________________________ |
___________________________________________________ |
Claimant signature |
Date |
Claimant signature* |
Date |
*Signatures are required for each passenger claiming lost property. Parents may sign for their children under age 18.