Damaged Baggage Declaration Form

1 Name
Mr. / Ms.

Address

Telephone number （home・office・mobile）

2 Baggage type （hard type / soft type）

Baggage color（white/black/blue/red/yellow/green/grey/others（ ）

Baggage brand name （ ）

3 Description of damaged areas

4 Date of purchase year month

Price (Yen/dollars)
Times of use times
5 Do you have a travel insurance ? Yes /No

※Please attach your ticket receipt, boarding pass and baggage claim tag.