LEYTE NORMAL UNIVERSITY

Tacloban City, Leyte

FLIGHT CANCELLATION FORM

using the Corporate Web Portal of Participating Airlines under the Governments Fares Agreement with PS-
DBM

Travel Details
Training/Event/Activity to be attended w
Inclusive Dates of Travel w
Destination w
Travel Order No. (please, attach photocopy) w

Passenger Details
Full Name of Passenger w

Flight Details
Booking Reference No/s. and Airlines w
w
Cost of the confirmed Flight Reservation to be
cancelled, excluding other cancellation fees to be
imposed by the airlines
w P
Reason/s for Flight Cancellation
Please check the applicable reason/s. a Cancellation is initiated by the airline/s.
(Attach notice/communication from the airline/s)

b Cancellation is due to bad weather.

(Attach weather advisory from DOST PAG-ASA)
The organizer cancelled, postponed, or
c
rescheduled the training, seminar, conference, or

(Attach official communication to serve as proof of the

cancellation, postponement, or rescheduling of the event
Due to medical reasons, the passenger is
d incapable to pursue the flight.
(Attach a copy of the medical certificate)
Cancellation is caused by the death of the
e passenger.
(Attach a copy of the death certificate)
Cancellation is due to the hospitalization of the
f
immediate family member of the passenger.
(Attach a copy of the medical certificate)
Cancellation is due to the death of the immediate
g
family members of the passenger.
(Attach a copy of the death certificate)
h Other Reasons (please elaborate below)

*Passengers are not liable to pay the cost related to the flight cancellation if the reason/s falls under the cases enumerated
in Items [a] to [g] as provided in the Internal Guidelines of the University for the Government Fares Agreement.
*All cost relative to and incidental to the flight cancellations due to reasons not covered under Items [a] to [g] shall be
entirely assumed by the passenger which should be paid over-the-counter at the Cashier’s Office within fifteen (15) days
from the date of flight cancellation. Promissory Notes are not allowed so as to maintain the liquidity of the credit line. The
cost includes: purchase price of ticket, net of refund; cancellation fees, and other applicable fees.

Prepared by: Noted by:

I declare that all information written above are true,

correct, and complete.

Signature over Printed Name of Passenger/

University President
Authorized Representative in case of Item [e]

Please forward the duly approved Flight Cancellation Form to the Travel Arranger at least one (1) day prior to the scheduled
flight. All cancellation shall only be entertained from 08:00AM to 12:00 noon so as to give time to the Travel Arranger in
facilitating the cancellation with the airline/s.

TO BE FILLED OUT BY THE TRAVEL ARRANGER

Date of Receipt of Flight Rebooking Form w
Date of Rebooking w

Travel Arranger

F-ACO-002 (09-02-19)