Baggage Tracing/Claim Form
File Reference Number ____________________
We are sorry your luggage was not available after your flight. Please accept our apologies for this inconvenience. Everything possible is being done to locate and return your property. Successful tracing and claim resolution requires prompt completion and return of this form. To avoid delays in processing, mail to: United Airlines Central Baggage Services - HDQLZ P Box 66140 .O. Chicago, IL 60666-0140 or email to web-baggage@united.com Please include the following documents: • Passenger ticket receipt(s) for each person involved in this loss. • Claim check(s) or copy of delayed baggage report for the missing property. • Excess baggage charge receipt, if applicable. • Excess valuation receipt, if applicable. • Attach Purchase Receipt(s) Or Proof Of Ownership For Articles Over $100.00.
United reserves the right to deny liability if this form is not received, or postmarked, within 45 days from the date of loss.
Please type or print and mail immediately
Name Mr. Mrs. Miss Home Address Home Phone Area code Business Phone Area code
(
Occupation
)
–
(
)
–
Employed By
City
Business Street Address
State/Province
E-Mail Address
State/Province
Zip/Postal Code
Country
Zip/Postal Code
Country
Total Bags Checked
Total Bags Lost
Number of Passengers Traveling
Social Security Number
Frequent Flyer Number/Airline
Flight Itinerary
From To Airline Flight Date Have you or any other family member had a previous baggage claim with any airline?
Yes
No
If Yes
Airline ________________________
Date __________________________ At what United office(s) have you reported your loss? When and where was the last time you saw your baggage?
Has loss been reported to another airline? Yes No
If yes, please give airline and city where reported.
UPS1747 REV 6/09 PRINTED IN U.S.A.
Any unusual circumstances surrounding this baggage mishandling (i.e.: reroute, bag switch, TSA involvement, etc.)?
Identification Name on Bag
Other Exterior Trademarks, Logos, Initials
Color of Bag
Brand
Date of Purchase
Original Cost
Successful recovery of your property requires accurate descriptions of the contents below. Please list contents individually. Note: Complete one form for each lost bag. Gender: M = Male, F = Female, CH = Child, Inf = Infant (0-3 Years) Attach Purchase Receipt(s) Or Proof Of Ownership For Articles Over $100.00
Article Color, Size, Material Label or Brand Gender M, F, CH, Inf Where Purchased Date Purchased Original Cost USD Other Currency Type Amount
If additional space is needed, please attach separate paper with same data as above.
Total value of bag and contents
Certification And Understanding
THE UNITED STATES POSTAL SERVICE HAS INVESTIGATIVE JURISDICTION UNDER FEDERAL LAWS RELATING TO SENDING FALSE OR FRAUDULENT CLAIMS THROUGH THE MAIL. SUCH CLAIMS RECEIVED BY UNITED ARE REPORTED TO THE POSTAL AUTHORITIES. LOSS OF BAGGAGE INVOLVING INTERSTATE SHIPMENT OR OF ARTICLES FROM SUCH BAGGAGE DUE TO THEFT COME WITHIN THE PURVIEW OF FEDERAL STATUTES 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 UNITED IN THE AMOUNT OF:
$ ____________ for loss occurring on ____________________________________________________________
Date
______________________________________________________________________________________________ Date Claimant’s Signature(s)*
______________________________________________________________________________________________ Date Claimant’s Signature(s)*
*Requires signature of each customer claiming lost property.
Please Note For travel wholly between points in the U.S., UA will not be liable for loss of money, jewelry, cameras, negotiable papers/securities, electronic/video/photographic equipment, heirlooms, antiques, artifacts works of art, silverware, irreplaceable books/publications/manuscripts/business documents, precious metals and other similar valuable and commercial effects. UA prohibits the foregoing items being placed in checked baggage for travel wholly between points in the U.S. as well as for international transportation.
Limits of Liability Domestic: Not to exceed $3,300.00 per ticketed passenger. International: International travel includes domestic segments when traveling in conjunction with an international ticket. • Warsaw Convention liability is $9.07 per pound, not to exceed 70 pounds per bag, up to a maximum of two bags per passenger. • Montreal convention liability is limited to 1,000 Special Drawing Rights (SDR) per ticketed passenger.
Attach the following items in the space below: • Passenger ticket receipt(s) for each person involved in this loss. • Baggage claim check(s) or copy of delayed baggage report. • Excess valuation receipts. Attach Purchase Receipt(s) Or Proof Of Ownership For Articles Over $100.00 Normal claim resolution is 45-60 days after receipt of requested items listed above.
Baggage Identification Chart Please circle the type of bag that most closely resembles your missing bag. In addition, circle any descriptive elements listed below which may help us in our investigation efforts.
Closes without zippers Types 01-12
Horizontal Design Hard Shell Upright Design Closes without zippers Types 01-12 Horizontal Design Suitcase Nonexpandable Horizontal Design Suitcase Expandable Briefcase
01
Document Case
02
Military Style Bag Plastic Laundry Bag
03
05
Box (if Single item use codes 01-99 with descriptive element B)
06
Storage Container
07
Garment Bag/ Suit Carrier Upright Design Soft Material
08
09
Upright Design Combined Hard and Soft Material
10
Upright Design Hard Material
12
Horizontal Design Suitcase
Closes with zippers Types 20-29
Closes with zippers Types 20-29
20
Duffel/ Sport Bag
22
Lap Top/ Overnight Bag Expandable Upright
22D
Matted Woven Bag
22R
23
Backpack/ Rucksack
25
26
27
28
29
DESCRIPTIVE ELEMENTS
MISCELLANEOUS ARTICLES - May have protective cover. Specify brand of article.
50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Hat Box. Courier Bag / Box / Package. Trunk / Sample / Display case - often custom made (describe item). Art or display portfolio. Tube - without sporting equipment. Duty-free articles - not covered or listed elsewhere (describe item). Cosmetic / Beauty case, any style. Kennel / Pet container. Ice chest / Cooler bag. Tool / Tackle box. Fishing rod(s) / poles / sticks (with or without container). Firearm(s). Golf bag and/or clubs - specify colour and brand of golf bag, when available (describe item). Bicycle and/or accessories (describe item). Sleeping bag / bed roll / tent (describe item). Surf Equipment (describe item, e.g. wind, kite, boogie, etc). Skis and/or ski poles (with or without container), Nordic walking poles. Specify colour and brand of skis/poles not the container. Snow boards / other sledding devices (with or without container). Specify colour and brand of item - not the container. Ski boots and/or boot bag. Specify colour and brand of boots, when available. Sporting equipment not listed elsewhere (describe item). 71 72 73 74 75 81 Child / Infant car seat. Child / Infant equipment not listed elsewhere (describe item e.g infant carrier, playpen, crib). Full size pram / baby carriage / jogger. Umbrella stroller. Wheeled sporting items (describe item e.g. skateboards, scooters, roller blades). Audio / Video / Visual / Photo equipment (describe item), e.g. television, DVD, video players and games, multimedia, radio, tape/cassette/CD player, amplifier, speakers. Computer / Computer equipment, e.g. computer monitor / keyboard / laptop computer / notebook computer / printer / computer game(s) / telephone / fax machine (describe item). Electrical appliances (describe item). All musical instruments (describe item). Camping / Folding / Collapsible chair (describe item). Baggage trolley. Security removed items (describe item). Shopping bag e.g. paper, straw, plastic, nylon. Wheel chair, powered or manual and accessories (seat, wheel, etc.). Orthopaedic devices other than wheelchairs and wheelchair accessories (seat, wheel, etc.). Bedding bag may contain pillows, blankets, duvet etc. Specialist dive bag / equipment. Beach, patio, golf and rain umbrella (all umbrellas). Article other than bag not appearing on this list (describe item).
COLOR CODES
WT White / Clear BK Black GY Grey / Silver / Aluminum BU Blue / Turquoise RD Red/ Maroon / Pink / Mauve / Burgundy YW Yellow / Orange / Gold BE Beige / Cream / Ivory BN Brown / Tan / Taupe / Bronze / Copper GN Green / Olive / Jade MC Two or more solid colors, excluding trim PR Print / Pattern / Floral / Spotted Tapestry / Stripe / Plaid / Checked PU Purple / Violet / Lilac
82
83 85 89 90 92 93 94 95 96 97 98 99
67
68 69