Air Canada Baggage Claim – Fill Out and Use This PDF

BAGGAGE DECLARATION

In the unlikely event that your missing baggage has not been returned to you within 5 days of your travel, you should complete this Baggage Declaration form.

The form has a dual purpose: to augment the tracing efforts and to be used as the basis of a claim should the search prove unsuccessful. We know that finding your missing baggage is more important to you than the limited indemnities described below. An erroneous or incomplete description will hamper the tracing in spite of our staff’s best efforts and could hinder any settlement.

If you reside in North America, the completed form should be mailed to our Montreal office at the address below. Residents of other countries should send it to the closest Air Canada office. PLEASE INCLUDE ALL AIRLINE TICKETS, BAGGAGE CLAIM CHECKS, AND EXCESS

BAGGAGE RECEIPTS (if applicable) AND RECEIPTS FOR ALL ITEMS CLAIMED MUST BE ATTACHED

TO SUBSTANTIATE YOUR CLAIM . PLEASE ATTACH A PHOTOCOPY OF A SIGNED PHOTO IDENTIFICATION. If you have homeowner/household insurance, baggage or credit card insurance against which you may claim, please complete question # 13.

Air Canada Baggage Claims

Air Canada ZIP 1116

P. O. Box 8000, station Airport

Dorval, Quebec

H4Y 1C3

Any claim must be made in writing wit hin 21 days of your arrival. This completed signed Baggage Declaration form is the official written notice of a claim. The report made at the airport is an incident report only. All claims will be processed as quickly as possible.

The Conditions of Contract on your ticket/e-ticket itinerary refer to limitations of liability based on tariffs, and/or the Warsaw Convention and/or the Montreal Convention. These amounts are not automatically payable but reflect what the maximum compensation might be, as each claim is subject to proof of loss.

Please note that special rules apply to fragile and perishable items and that consequential damages such as loss of enjoyment, loss of business, inconvenience, etc. are not compensable.

Please also note that for domestic travel within Canada, or for any travel where none of the aforementioned Conventions apply, airlines are not liable for the loss of money, jewellery, silverware, samples, business documents, electronic equipment or other valuable articles, whatever the circumstances.

Thank you for your cooperation and understanding. We sincerely hope that our combined efforts will result in the prompt return of your missing property.

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PLEASE ATTACH A PHOTOCOPY OF A SIGNED PHOTO IDENTIFICATION (MANDATORY)

Frequent Flyer ID : ___________________________________

Dat e of Birt h : _____________________________________

(Optional)yy/mm/dd

Residence Address :

___________________________________________________________________________________________

___________________________________________________________________________________________

Residence Tel (____)___________________________ Cell (____)____________________________________

E-Mail : ___________________________________________________________________________________

Company Name : ________________________________________________________________+___________

Business Address : ___________________________________________________________________________

Business Tel.: (____)_________________________________________________________________________

Any prior address (wit hin past 2 years): ____________ ____________________ _________________

__________________________________________________________________________________________

Prior Tel .: (____)___________________________________________________________________________

Have you, or any member of your household, ever had a previous claim with Air Canada or any

other airline?  YES  NO

If yes, give name of Carrier _______________________ and date _________________________________

For t he purpose of t racing your baggage as well as processing and verifying your claim, it is somet imes necessary t o disclose personal informat ion t hat you have provided us t o a baggage t racing dat abase (World Tracer), which is accessible by ot her part icipat ing airlines and handling agencies.

I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath. I understand this declaration may be subject to review and investigation and I hereby give Air Canada the authority to require from anyone any documents or statements in relation to this declaration.

According to section 131 and 132 of the Criminal Code, any person who makes a solemn declaration knowing that the declaration is false, is guilty of an indictable offense and may be liable for imprisonment for a term not exceeding fourteen years. Similar laws are applicable in other countries.

I also understand that Air Canada may disallow any claim for loss, which contains misrepresentations, including false statements concerning whether or not previous claims have been made with Air Canada or other carriers.

Claimant’s Signature ________________________________________ Date: ______________________

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ATTACH YOUR AIRLINE TICKET(S)/ BAGGAGE CLAIM CHECK’ S AND EXCESS BAGGAGE RECEIPTS (IF APPLICABLE)

RECEIPTS FOR ALL ITEMS CLAIMED MUST BE ATTACHED

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Airline Baggage Identification Chart

Circle appropriate item and supply Brand, Color and Size descriptions

Circle any descriptive elements (pockets, wheels, etc. )

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DOCUMENT CHECKLIST

Did you enclose:

θAirline Ticket (s) / E- Ticket / It inerary

θBaggage Claim Check(s)

θBoarding Pass

θOriginal Purchase Receipt s

θIt emized list for each addit ional bag

θPhot ocopy of signed phot o ident ificat ion

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