SUCCESSFUL RECOVERY OF YOUR PROPERTY DEPENDS ON BEING AS ACCURATE AS POSSIBLE IN
DESCRIBING THE CONTENTS BELOW. PLEASE LIST ALL ARTICLES REGARDLESS OF MONETARY VALUE.
NOTE: When more than once piece of luggage is missing, please list contents of each piece separately.
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DESCRIPTION OF CONTENTS |
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*Gender: M=Male, F=Female, MC=Male Child, FC=Female Child |
Age of Child:______________ |
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Qty |
Article |
Color |
Size |
Material |
Label Or Brand |
Gender* |
Store & City |
Date |
Original Cost |
Other Currency |
Purchased |
Purchased |
USD |
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Type Amount |
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1 |
Shirt |
Blue |
L |
Cotton |
ABC |
M |
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ACME/Chicago |
3/1/1995 |
30 |
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If additional space is needed, please attach separate paper with same data as above. |
Total Value of Bag & Contents |
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______________
Claimant Signature_________________________________________________________________________________________________ Date ____________________________
Witness Signature _________________________________________________________________________________________________ Date ____________________________
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.