Dear American Airlines Customer,

We would like to apologize for the inconvenience the delay of your baggage has caused you. The following pages will
assist us in locating your property and our tracing is dependent on the completion of this form.
Once the form has been returned to us, we will intensify our tracing efforts with the goal of locating and returning your
property. That is why it is important that the itemization of the contents in the delayed baggage is very specific with a
complete description of each item in the bag. For example, tell us the brand names, colors, sizes and material for each
and every item in the delayed baggage. If it is necessary to attach a separate page with the information we require,
please provide it to us. If more than one bag is delayed, make sure to list specific contents for each bag that is delayed.
Before getting started, keep in mind that you complete all areas of this form and return it to us no later than 30 days from
the date of travel. Also, be sure to include ticket receipts, baggage claim checks, receipts for excess value claimed or
excess baggage charges paid, receipts for all items valued over $150.00 and clear and legible copies of government
issued photo identification for each passenger making a claim. Examples of acceptable identification include: state issued
drivers license, Federal or State issued Identification Cards and government issued Passports. Failure to return this
completed form to us within the timeframe we allow will result in the denial of your claim.
Check list:
Airline ticket receipts
Baggage claim checks
Receipt(s) for excess value claimed
Receipt(s) for excess baggage charges paid
Receipt(s) for all items valued over $150.00
Clear and legible government issued photo identification for each passenger making a claim
Tell us about previous baggage claims with AA or any other airline
Once you have completed the form, please return it to us by mail or fax:
American Airlines, Inc.
Central Baggage Service
PO Box 619613 MD 1322
Dallas/Ft. Worth, TX 75261-9613
Fax: 972-425-0714
Email: PPQ1600@aa.com
Finally, we realize that this experience has been frustrating for you and it is our goal to resolve this as promptly as
possible. Please make a copy of this completed form for your records and return it to us within 30 days from the date of
travel.
Thank you for your cooperation,

Your American Airlines Central Baggage Service Team

Property Questionnaire
Record Locator: _______________

AAdvantage No.___________________

Were focused on resolving your claim quickly. Please complete this form and return it to us within 30 days from the date of
travel. To get started, well need the following: ticket receipt(s), baggage claim check(s), receipt for excess value claimed
or excess baggage charges paid, copy of government issued photo identification for each claimant, and receipts for items
valued over $150.00. The more information you can provide, the better we can help you.
Mr.
Mrs.
Ms.

First

Permanent Mailing
Apt.
Address
City
Zip Code

Middle

Number

Last Name

Phone Number:
Home:
Temporary Mailing
Apt.
Address
City
Zip Code

Street

State

Country
Postal Code

Country
Postal Code

Employed by:
Occupation:

E-mail:
Number

Business:
Street

Number

State

Cell Phone

Your Complete Flight Itinerary

From

To

Airline

Flight Number

Travel Date

In the past 3 years, have you, or any member of your household, had a previous baggage claim with AA or any other airline?

Yes

No

If yes, list each airline, claimant name and dates (attach an additional page if necessary)
Airline(s) ___________________________________________ Name(s) _________________________________
Date(s)________________________________
Information gathered on this form may be shared with other airlines, local, state and federal law enforcement agencies or private insurers.
No. of ticketed
passengers traveling:

Number of passengers
claiming missing baggage:

Were you charged for excess baggage?

Yes

Purpose of trip?

Did you declare and pay for excess value?

Length of stay?

Yes

Value declared:

$______________
No

No

Have you received your baggage and are you missing contents only?
Was airline notified of loss immediately?

Yes

No

Yes

No

If yes, how many bags are missing contents?

If yes, at what office?

By Telephone

In person

If airline was not notified within 4 hours, state the reason for delay.
Where and when did you last see your baggage?
Has this loss been reported to another airline?

Yes

No

If yes, please provide name of airline and city where reported.

Certification and Understanding

APPLICABLE IN USA ONLY. It is expressly understood and agreed by the claimant that the furnishing of this form and any assistance given by employees
of American Airlines, Inc., are acts of courtesy and shall not constitute a waiver of any rights or an admission of liability by or on the part of American
Airlines, Inc., its employees or agents. Any other information and/or documents relating to this statement which are required by American Airlines, Inc., will
be furnished by claimant upon request and shall be considered part of this statement.
The United States Post Office has investigative jurisdiction under federal laws relating to sending false or fraudulent claims through the United States mail
and any such claims received by American Airlines, Inc., are reported to the United States Postal Authorities. Loss of baggage in interstate shipment or of
articles from such baggage come within the purview of federal statutes relating to thefts from interstate shipment and, are therefore, subject to investigation
by the Federal Bureau of Investigation.

Reply to:
Central Baggage Service
PO Box 619613 MD 1322
Dallas/Ft. Worth, TX 75261-9613
OP124 (Rev 11/2013) CPN 5689520

American Airlines, Inc.

Toll Free:
1-800-866-4010
Local:
972-425-5240
Fax:
972-425-0714

Complete Reverse Side

BAGGAGE AND CONTENT DESCRIPTION

NOTE: When more than one piece of baggage is lost, complete a separate baggage and content list for each missing bag.
Baggage routing:

Flight number(s) on claim check:

Airport checked from:

Baggage tag number(s):

Airport checked to:

Passenger ticket number(s)

Number of bags checked:

Number of bags received:

Was baggage rechecked and new tags issued? Yes

No

Was baggage available at Customs?

N/A

Yes

No

Baggage checked at: Curbside

Ticket Counter

Gate

Other

If yes, at what airport?

Give details if the original routing was changed after starting your trip:
Was your property packed in a box?

Yes

No

Was your property packed with an external cover? (example golf bag)

Yes

No

Is the name on the bag(s) different from passenger? If so, what name?
Please list any initials, marks, tags, ribbons, cords, tape or other exterior markings on your bag(s):

Bag
Type

Material

Color

Brand

Bag
Dimensions

(see chart)

Open/Clos
e
with Zipper

Yes
No

Gender = M: Male

Wheels

Yes
No

Combo
Lock

Pockets

Yes
No

Yes
No

F: Female CH: Child

Qty

Size

Gender
M, F, CH, I

Shoes

12

White with blue stripes

Leather

T-Shirts

Undershirts

Cotton

Color

White

Handle

Purchase
Date

Cost
of Bag

Yes
No

Yes
No

I: Infant (under 2 yrs)

Article/
Item

Description

Retractable

Straps

Material

Store
Purchased

Purchase
Date

Nike

Sears

Jan-13

$55.00

Hanes

JCP

Jan-13

$20.00

Brand Label

TOTAL:

Original
Cost

If additional space is needed, please attach a separate page. Be sure to include a complete
description and cost for each item along with receipts for all items valued over $150.00.
I do hereby warrant the foregoing statement and those on the accompanying forms to be accurate, complete and true. I hereby
make a claim against American Airlines, Inc., in the amount of $_________________ for a loss occurring on _________________.

Claimant signature
*

Signatures

are

required

Date
for

each

passenger

claiming

Claimant signature*
lost

property.

Parents

Date
may

sign

for

their

children

under

age

18.

BAGS THAT CLOSE WITHOUT ZIPPERS

01 HORIZONTAL DESIGN, GENERALLY HARD SHELL
02 UPRIGHT DESIGN, GENERALLY HARD SHELL
03 HORIZONTAL DESIGN, RIGID FRAME, HARD OR SOFT
SIDE/MAY HAVE REINFORCED CORNERS
05 HORIZONTAL DESIGN, RIGID FRAME, SOFT SIDED, EXPANDABLE
06 BRIEFCASE
07 FLIGHT/PILOT'S BAG/DOCUMENT CASE
08 MILITARY STYLE BAG
09 PLASTIC/LAUNDRY BAG
10 CARDBOARD/WOODEN BOX
12 STORAGE CONTAINER; MAY HAVE HANDLE/WHEELS
BAGS THAT CLOSE WITH ZIPPERS
20 HANGING OR FOLDING GARMENT BAG
22 UPRIGHT DESIGN, SOFT MATERIAL RETRACTABLE HANDLE
22D UPRIGHT DESIGN COMBINED HARD AND SOFT MATERIAL
22R UPRIGHT DESIGN, DURABLE, PLASTIC, MOLDED
23 HORIZONTAL DESIGN SUITCASE THAT SECURES WITH ZIPPER
25 GYM/SPORT TYPE BAG ALL SIZES, MAY HAVE SHOULDER
STRAP AND RETRACTABLE HANDLE
26 SMALL OVERNIGHT OR LAPTOP BAG
27 STANDS UPRIGHT, MAY BE EXPANDABLE, OFTEN HAS WHEELS
28 MATTED WOVEN BAG
29 BACKPACK/RUCKSACK WITH OR WITHOUT FRAME, MAY HAVE
RETRACTABLE HANDLE AND WHEELS
MISCELLANEOUS ARTICLES SPECIAL CONTAINERS
50 HAT BOX
51 COURIER BAG/BOX/PACKAGE
52 TRUNK/SAMPLE/DISPLAY CASE *OFTEN CUSTOM MADE*
53 ART OR DISPLAY PORTFOLIO
54 TUBE WITHOUT SPORTING EQUIPMENT
55 DUTY FREE ARTICLES (NOT LISTED ELSEWHERE)
56 COSMETIC/BEAUTY CASE, ANY STYLE
57 KENNEL/PET CONTAINER
SPORTING GOODS
60 FISHING RODS/POLES/STICKS
61 FIREARM(S)
62 GOLF BAG AND/OR CLUBS SPECIFY COLOR AND BRAND
63 BICYCLE AND/OR ACCESSORIES
64 SLEEPING BAG/BED ROLL/TENT
65 SURF EQUIPMENT E.G. WIND, KITE, BOOGIE
66 SKIS AND/OR POLES, NORDIC WALKING POLES
67 SNOW BOARDS AND OTHER SLEDDING DEVICES
68 SKI BOOTS AND/OR BOOT BAG
69 SPORTING EQUIPMENT NOT SHOWN ELSEWHERE
75 WHEELED SPORTING ITEMS E.G., SKATEBOARDS, SCOOTERS
89 CAMPING, FOLDING, COLLAPSIBLE CHAIR
BABY/INFANT/CHILD EQUIPMENT
71 CHILD/INFANT CAR SEAT
72 CHILD/INFANT EQUIPMENT NOT LISTED ELSEWHERE E.G., INFANT CARRIER, PLAYPEN
73 FULL SIZE PRAM/BABY CARRIAGE/JOGGER
74 UMBRELLA STROLLER
PHOTOGRAPHIC/ELECTRONIC/MUSICAL/COMMUNICATION EQUIPMENT
81 AUDIO/VIDEO/VISUAL/PHOTO EQUIPMENT E.G., TELEVISION, DVD, VIDEO PLAYERS AND GAMES, RADIO, TAPE/CASSETTE/CD PLAYER
82 COMPUTER/COMMUNICATION EQUIPMENT E.G. PC COMPUTER, MONITOR, KEYBOARD, LAPTOP, PRINTER, COMPUTER GAMES,
TELEPHONE, FAX MACHINE
83 ELECTRICAL APPLIANCES
85 ALL MUSICAL INSTRUMENTS
MISCELLANEOUS ARTICLES
90 BAGGAGE TROLLEY
92 SECURITY REMOVED ITEMS
93 SHOPPING BAG E.G., STRAW, PLASTIC, NYLON
94 WHEELCHAIR POWERED OR MANUAL AND ACCESSORIES E.G., SEAT,WHEEL, ETC.
95 ORTHOPEDIC DEVICES OTHER THAN A WHEELCHAIR
96 BEDDING MAY CONTAIN PILLOWS AND BLANKETS
97 DIVE BAG/EQUIPMENT
98 BEACH, PATIO, GOLF, AND RAIN UMBRELLA
99 ARTICLE OTHER THAN BAG NOT APPEARING ON THIS LIST DESCRIBE ITEM