Delta Form Property – Fill Out and Use This PDF

Property Loss Claim Form

5-1078 Rev 12.09

You will likely receive your luggage within 24 hours. In the unlikely event you do not, please contact the airport at which you filed the claim. If after 5 days, you still have not received your luggage, please fill out this form and submit it and all supporting documentation to:

Delta Air Lines. Inc. Customer Care Baggage, P.O. Box 20598 Atlanta, GA 30320-2598

Fax Number: (888) 880-3412

PLEASE DO NOT FILL OUT AND MAIL FORM UNTIL AFTER 5 DAYS HAVE ELAPSED WITHOUT YOUR LUGGAGE.

We are sorry your luggage was not available after your recent flight. Please accept our apology for the inconvenience this caused. Everything possible will be done to locate and return your property to you promptly. Successful tracing and resolution of this claim depends upon prompt completion and return of this form for each bag that is missing along with the following required documents:

- Passenger ticket receipt(s) for each person involved in this loss. - Claim check(s) or claim check receipt for the missing property.

- Purchase receipt(s) or proof of ownership for all items valued at $250.00 (U.S.) or more.

Delta Air Lines, Inc. reserves the right to deny liability if this form is not received, or postmarked, within 21 days from date of loss.

PLEASE TYPE OR PRINT AND MAIL IMMEDIATELY

Yes No

YOUR COMPLETE ITINERARY

Number of pieces checked______________________ Number missing_______________ Estimated weight of each missing piece ___________________

Where did you last see your luggage? _________________________________________________________________________________________________

If loss not reported immediately, explain reason for delay ________________________________________________________________________________

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FORM NO. 5-1078 12/2009

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.

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.

RETAIN A COPY OF ALL DOCUMENTS (e.g., CLAIM FORM AND RECEIPTS). MAIL THE ORIGINAL DOCUMENTS

WITHIN 21 DAYS FROM THE DATE OF LOSS TO THE ADDRESS AT THE TOP OF THE FIRST PAGE.