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Departure airport *

Destination airport *

Airline *

Travel Date *

e.g 14/5/2024

Claim type? *

Delay period? *Note: Delayed claims must be for 3+ hour delays

Flight number (if known)

Booking Ref. (if known)

Total number of passengers for claim?

Primary applicant details

First Name *

Last Name *

Your Full Address *Enter your full address with postcode and country

Date of Birth

Main applicant must be 18+

Email Address

Phone *

Add Additional PassengersAdd any passengers to be included in this claim

P2 First Name

P2 Last Name

P3 First Name

P3 Last Name

P4 First Name

P4 Last Name

P5 First Name

P5 Last Name

Add P6 – 10Add any passengers to be included in this claim

P6 First Name

P6 Last Name

P7 First Name

P7 Last Name

P8 First Name

P8 Last Name

P9 First Name

P9 Last Name

P10 First Name

P10 Last Name

Additional information (Optional)

Credit / Debit Card *