Translation from the German language Sender: Bundesamt für Justiz (Federal Office of Justice) Schlichtungsstelle Luftverkehr (Air Transport Arbitration Body) 53094 Bonn, Germany Application 1 for arbitration proceedings to be conducted under the Luftverkehrsgesetz (LuftVG Civil Aviation Act) I hereby apply for arbitration proceedings to be conducted under Section 57 et seq. of Luftverkehrsgesetz with the airline 2... (Name of airline) Schlichtungsstelle Luftverkehr, Bundesamt für Justiz, last updated: 1 August 2018 due to being denied boarding. delayed flight. being downgraded to a different class. flight cancellation. destruction of, damage to or loss of baggage. delayed arrival of baggage. destruction of, damage to or loss of items which I was wearing or carrying with me during the flight. Failure to carry out duties relating to the carriage of disabled or physically impaired passengers. I am submitting a claim for a payment of... EUR. 1 If you are not making your application by email, please ensure that you include two copies of your application and all accompanying documents. For more assistance in making your application for arbitration, you can download a checklist from www.bundesjustizamt.de/luftverkehr (in German). 2 N.B.: appointed private arbitration body. For more information, visit www.bundesjustizamt.de/luftverkehr (in German) or phone +49 (0) 228 99 410-6120. 15.03.20171
I. Applicant s details... (forenames, surname, ne(é) where applicable) Date of birth:... Place of birth:... (date) (place/country) Place of residence:... (please include place, street name and post code) Phone:... Fax:... Email address:... I consent to being contacted by the Federal Office of Justice in its capacity as Air Transport Arbitration Body using the email address provided above. I ensure that I booked and took the flight(s) stated below as a consumer as defined by Section 13 BGB (Bürgerliches Gesetzbuch Civil Code), i.e. the flight was not primarily for commercial purposes nor for the purposes of carrying out business in a self-employed capacity. II. Legal counsel in the proceedings 3 I am representing the applicant in the arbitration proceedings.... (forenames, surname, né(e) where applicable)... (please include place, street name and post code) Phone:... Fax:... 3 Please include a copy of the authorisation given by the passenger to the legal counsel. You will find an example of an authorisation (in German) on the website of the Federal Office of Justice at the following address: www.bundesjustizamt.de/luftverkehr. 15.03.20172
Email address:... An authorisation in writing is enclosed. will be submitted as soon as possible. III. Bank details 4 Account details:... (Name of bank) IBAN:... BIC:... Account holder:... (if different from the applicant) IV. Flight details Airline:... Flight number:... Departure airport:... Date of departure:... Scheduled time of departure:... Destination airport:... Date of arrival:... Scheduled time of arrival:... Actual time of arrival:... (to be stated if your flight was delayed) 4 Please provide valid bank account details, stating both the IBAN and the BIC. If you do not do this, any payment agreed on by the airline may not reach you. 15.03.20173
Other (connecting) flight where applicable Airline:... Flight number:... Departure airport:... Date of departure:... Scheduled time of departure:... Destination airport:... Date of arrival:... Scheduled time of arrival:... Actual time of arrival:... (to be stated if your flight was delayed) Date flight was booked:... How was the booking made (online, at a travel agent s, etc.)?... Cost of flight (total)... EUR 15.03.20174
V. Your statement Please describe the circumstances which led to your claim. What, in precise terms, is your complaint against the airline? What losses did you suffer as a result? Were you travelling alone or were you with members of your family, your spouse or civil partner? Who made the booking? What was the response of the airline to your complaint/claim? Please continue on a separate sheet of paper if you run out of space. VI. Claims filed directly with the airline I have already filed my claim by contacting the airline directly. I did this on 5 :... The airline has rejected my claim. The airline has offered me a payment of... EUR. I do not wish to accept this offer. The airline has offered me travel vouchers worth... EUR. I do not wish to accept this offer. Miscellaneous: 5 It is not possible to enter into arbitration proceedings until you have filed any claims you have with the airline. If you have yet to do so, you will need to contact the airline directly in the first instance. 15.03.20175
VII. Supporting documentation Please include copies of all supporting documentation with your application as could be necessary or useful (such as your ticket, statement of losses suffered, letters of complaint to the airline, the airline s response, etc.). If you do not do this, there may be delays in processing your application or it may even be refused completely. Please note that, under the terms of Section 11 of the Luftschlichtungsverordnung (Air Transport Arbitration Ordinance), failure to cooperate with the arbitrator in providing him/her with information, documents or answers to his/her questions by the deadline set will result in your application being considered withdrawn. No arbitration proceedings will be carried out under such circumstances. I have enclosed copies of the following supporting documentation (continue on a separate sheet if necessary): VIII. Declarations In the same matter/in relation to the same flight, for which I wish to make a claim against the airline by way of these arbitration proceedings, I have already been in contact with a court. The name of the court in question is arbitration proceedings have already been carried out. I have already contacted an arbitration body or a dispute-resolution entity. The name of the organisation in question is I have already come to an agreement with the airline in relation to the following issues 15.03.20176
IX. Data protection notice and declaration of consent The Air Transport Arbitration Body (Division VIII 4) at the Federal Office of Justice (Bundesamt für Justiz BfJ), 53094 Bonn, Germany, processes personal data as defined in Article 4 Number 2 of the General Data Protection Regulation (GDPR) in accordance with Article 6 Subsec. 1 letter e, and Subsec. 3 letter b of the GDPR in connection with Sec. 3 of the Bundesdatenschutzgesetz (Federal Data Protection Act) in fulfilment of its duty as a governmental arbitration body as defined in Sec. 57a Subsec. 1 of the Luftverkehrsgesetz (LuftVG Civil Aviation Act) for the purpose of carrying out arbitration proceedings in accordance with Sec. 57 et seq. of the Civil Aviation Act. The Air Transport Arbitration Body requires certain data from the passenger so as to be able to carry out arbitration proceedings. If this data is not provided voluntarily, no arbitration proceedings can be carried out. If the legal conditions are fulfilled, the Air Transport Arbitration Body forwards the arbitration request which contains the personal data provided by the passenger to the airline named by the passenger or to a law firm which this airline has elected as an authorised recipient (Sec. 13 Subsec. 1 first sentence of the Luftverkehrsschlichtungsverordnung (Air Transport Arbitration Ordinance)). If it is not possible to call upon the Air Transport Arbitration Body to deal with the dispute, but it is possible to call upon another arbitration body, then the Air Transport Arbitration Body shall hand the arbitration request to the other arbitration body (Sec. 12 Subsec. 1 second sentence, Air Transport Arbitration Ordinance). The passenger shall then be informed that the arbitration request has been handed over, and told which other arbitration body it has been handed to. If the address known to the air transport arbitration body for the airline named by the passenger is outside of Germany, then the arbitration request which contains the personal data provided by the passenger shall be sent to the country in question. This may be a country outside of the European Union, for which no European Commission adequacy decision exists as to whether the country in question ensures an adequate level of data protection. Beyond this, please take note of the general data protection declaration on the homepage of the Federal Office of Justice (www.bundesjustizamt.de/datenschutz). I have read and understood this data protection notice. I hereby consent to the data I have provided being processed as defined in Article 4 Number 2 of the GDPR in the way described in the Regulation for the purposes of arbitration proceedings pursuant to Sec. 57 et seq. of the Civil Aviation Act.... (Place and date)...... (Applicant s signature) (Signature of legal counsel) 15.03.20177