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Assertion of compensation claims according to
Art. 7 Regulation (EC) No. 261/2004
Dear Sir/Madam,
I hereby claim compensation according to Art. 7 of Regulation (EC) No. 261/2004 for:
1. Your Name / Street / Postal Code / City / Country _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. Name of other Passengers (for example your Wife/Husband or Children) _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I claim compensation relating to flight number: _ _ _ _ _ _ _ which I booked from
departure airport _ _ _ _ _ _ _ _ _ _ _ _ to arrival airport _ _ _ _ _ _ _ _ _ _ _ _ _ on
booking date _ _ _ _ _ _ _.
The flight was delayed for more than _ _ _ _ _ hours OR _ _ _ canceled OR _ _ _ took
place without me.
The problem was not based on exceptional circumstances or act of god.
Due to the delay of _ _ _ _ _ hours and the flight distance of _ _ _ _ _ between the
airports I have the right to be compensated by _ _ _ _ _ Euros for each passenger.
I am writing this letter to request you to pay an amount of _ _ _ _ _ Euros / Passenger
for each passenger, which comes to a total amount of € _ _ _ _ _ immediately, but not
later than 21 days from the date of this letter.
My bank account is Bank: _ _ _ _ _ _ _ _ _ _ _ _ _ _
IBAN: _ _ _ _ _ _ _ _ _ _ _ _ _ _ Swift/BIC: _ _ _ _ _ _ _ _ _ _ _ _ _ _
I