PLEASE ENSURE THAT YOU SAVE THIS DOCUMENT ON YOUR COMPUTER BEFORE

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1 Apprved Aviatin Adjudicatin Applicatin Frm What is this Applicatin fr? This applicatin frm is fr passengers t bring a claim against an airline r airprt if they have nt been able t reslve the cmplaint directly with them. The applicatin frm will ask yu fr the details needed t understand what yu wuld like the airline t d and t help an adjudicatr decide yur dispute What d I need t d? Read the Guidance fr Passengers fact sheet. If yu are unsure f hw t answer a questin please cntact CEDR fr guidance Fill in the applicatin frm giving as much infrmatin as yu can. If yu are claiming fr things that have been lst r damaged remember t include any receipts yu have It may take yu sme time t g thrugh the applicatin frm and t get all yur facts tgether, but having all the infrmatin will help CEDR assess yur case fairly. Yu must have already cmplained t the airline befre yu can make an applicatin t CEDR. Yu can nly make an applicatin if yu have nt been able t settle yur dispute with the airline r airprt directly after eight weeks has elapsed since yu first cmplained r if the airline/airprt has prvided yu with its final respnse in relatin t the dispute, therwise knwn as a final psitin r deadlck letter Please let us knw if yu have any practical needs where we culd help fr example with infrmatin in anther frmat (e.g. larger print, Braille etc.) r in anther language. If yu require assistance in cmpleting this frm please cntact CEDR: By telephne: By aviatin@cedr.cm Web: CEDR pening hurs: 9:00am t 5:00pm, Mnday t Friday 1. Abut yu Please give us yur details. Full name: Street Address: Twn: Cunty: Pstcde: Tel: Daytime number address: If yu prvide an address we will nrmally send yu infrmatin by nly. PLEASE ENSURE THAT YOU SAVE THIS DOCUMENT ON YOUR COMPUTER BEFORE SENDING

2 2. Representatin If smene is cmplaining n yur behalf, please cmplete and sign the Representative Authrity Frm at sectin 9. Representative Authrity Frm and prvide prf f yur identities. Prf f identity must clearly display each custmer s name and signature, e.g. passprt r driving licence. 3. Flight details Please tell us abut the flight this claim relates t r name the airprt if the cmplaint is abut Airline r Airprt: Number f additinal passengers n the bking (if applicable): Names f additinal passengers n the bking (if applicable): Bking number: EG. GHG Flight number: EG. AB1234 Departure airprt: What time was the flight scheduled t depart? What time was the aircraft scheduled t arrive? What time did the aircraft land at the destinatin (if knwn)? What time did the aircraft drs pen at the gate (if knwn)? Date f departure: DD/MM/YYYY Destinatin airprt: 4. Cmplaint Histry On what date did yu cmplain t the airline r airprt? DD/MM/YY On what date did they send yu a final psitin letter? DD/MM/YY The final psitin letter sent by the airline r airprt shuld tell yu that yu have reached the end f their cmplaints prcess and shuld advise yu that yu may refer yur cmplaint t CEDR if yu wish. Please prvide the cmplaint reference number given by the airline r airprt CEDR Applicatin Frm Page: 2

3 5. Cmpensatin Claimed Please prvide details f the cmpensatin that yu wuld like the airline r airprt t prvide by itemising yur claim in the table prved. Yu shuld prvide details f each item yu wish t claim fr, why, and hw much. Once submitted, the amunt claimed cannt be changed. Item Amunt Claimed ( ) EG. Flight delayed by x hurs.. Please cntinue n a separate sheet if required but ensure that the ttal amunt yu are claiming is cmpleted in the next bx belw. Ttal Claimed: 6. Evidence Please send us any dcuments that supprt yur claim such as: Bking frms Crrespndence Flight schedules Media (Audi / with the airline Vide) Phtgraphs Receipts Other evidence yu cnsider relevant (please specify belw) 7. Other infrmatin Please prvide details f any ther issues that yu believe are relevant t yur claim (Cntinue n a separate sheet if necessary) CEDR Applicatin Frm Page: 3

4 8. Payment infrmatin If yur claim is 100% unsuccessful yu will be asked t pay a cntributin f 25 twards the cst f the adjudicatin. Please nte that this is a cst per case and nt per passenger. Yu will nt be charged anything if yur claim is successful and yu will receive 100% f the cmpensatin awarded by the adjudicatr. 9. Representative Authrity Frm Please nte that yu and all ther passengers n the bking must sign this frm belw and prvide prf f their identities. This prf f identity must clearly display the custmer s name and signature, ie. passprt / driving license. 1. I/We hereby give authrity fr the persn named belw t represent me/us in my applicatin fr CEDR adjudicatin. 2. I/We understand and accept that the adjudicatin will be cnducted in accrdance with CEDR s Scheme Rules. 3. I/We understand that it is my/ur respnsibility t read the available guidance, which can be fund n CEDR s website r by cntacting the CEDR ffice, and/r ensure that the representative stated belw has dne s in rder t understand the adjudicatin prcess. 4. I/We understand that, if directed by the adjudicatr, the airline/airprt will prvide any payment f redress directly t me and nt t my representative. Each custmer will need t prvide bank details s that they can be paid directly t a bank accunt in their name. 5. I/We acknwledge that each passenger n the bking must sign belw and prvide a cpy f an apprved frm f identificatin that displays the passenger s signature (e.g. driving licence, passprt). Representatin details Signed by the passenger CEDR Applicatin Frm Page: 4

5 10. Declaratin Data Prtectin Act The Data Prtectin Act allws CEDR subscribing airlines t prvide infrmatin and/ r dcuments abut yu t CEDR Scheme administratrs and the adjudicatr with yur cnsent. By cmpleting this frm yu are giving yur cnsent. Please tick all bxes in this sectin. I understand and accept that the adjudicatin will be cnducted in accrdance with the CEDR Rules f the Independent Redress Scheme fr Air Passengers. I understand that infrmatin relating t the adjudicatin scheme is available either frm the CEDR website r by cntacting the CEDR ffice. I understand that it is my respnsibility t read the available infrmatin in rder t understand the adjudicatin prcess and that I can cntact CEDR fr guidance n the prcess if necessary. I have nt previusly referred this dispute t a curt f law. I understand that the airline r airprt will prvide infrmatin abut me t CEDR. I agree t pay CEDR the sum f 25 if my applicatin is 100% unsuccessful. Signature: Print name: Date: Submitting yur applicatin Nw please submit yur applicatin and supprting evidence t us: By pst: By Online By fax: Centre fr Effective Dispute Reslutin Aviatin Adjudicatin 70 Fleet Street, Lndn, EC4Y 1EU aviatin@cedr.cm PLEASE ENSURE THAT YOU SAVE THIS DOCUMENT ON YOUR COMPUTER BEFORE SENDING CEDR Applicatin Frm Page: 5