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Complaints in case of denied boarding cancellation or long delay of
Complaint form

PASSENGERS Complaint form in case of denied boarding, downgrading, cancellation or long delay of flight under Regulation (EC) 261/2004

Complaint presented by

Name*

Surname*

Permanent Address (Residence) *

City*

Postal Code*

Country/Nation*

E-mail*

sent to the carrier on

Reasons of complaint*

Denied boarding (art.4)

Flight cancellation (art.5)

Delay on departure for two hours or more in respect of the time of departure indicated on the passenger's reservation

Delay on arrival at final destination three hours or more later in respect of the time of arrival indicated on the passenger's reservation

Failure to provide passenger rights information (art. 14)

Flight

Airport where the event occurred*

Air Carrier*

Flight number*

Flight Date* date date

Airport of Departure*

Airport of Destination*

Intermediate Airport

Expected time

Hour * Expected time Hour

Minutes* Expected time Minutes

Actual Time

Hour Actual Time Hour

Minutes Actual Time Minutes

Booking Code*

Flight only

All inclusive trip (Travel package)

Were you informed of your rights ? At check in

At boarding

Did you receive assistance? YES

Type of assistance provided Meals

Snacks

Hotel accomodation

Transfers

Phone calls /e-mail

Did the air carrier offer you re-routing on an alternative flight? YES

Did the air carrier reimburse the cost of the ticket? Fully

Partially

Did you receive financial compensation, if due (denied boarding,
flight cancellation or delay at final destination of at least three hours
or more after the arrival time originally scheduled) ? YES

In case of a delay of more than 5 hours, did the air carrier offer the possibility
of not taking the flight and the consequent reimbursement of the cost of the ticket? YES

Note

Additional Information useful for the evaluation of the complaint (up to 1000 characters)

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