Customer Property Claim Form (Page 4 of 4) in pdf

Attach Original Baggage

Claim Check(s) HERE

Baggage Report Number # __________________

Description of Property

(All items should be listed separately.)

Male /

Store

Original

Receipt

Article / Item

Female

Description

Color

Material

Brand

Size

Purchase Date

Purchased

Price

Attached?

/ Child

(EXAMPLE)





Grey with Blue Stripes

Canvas

Nike

Foot Locker

10/15/04

$64.00

Yes

Shoes

 Yes  No

Note: If additional space is needed, please attach separate paper with same data as above.

NOTICE TO CLAIMANT

The Claimant expressly understands and agrees that the furnishing of this form and any assistance by agents or employees of Spirit Airlines are only acts of

courtesy and are not to be construed as waiver of any rights or admission of any liability by or on behalf of Spirit Airlines, its employees or agents. Upon

request, the Claimant must furnish any other information and/or documents relating to this claim which are required by Spirit Airlines. All claims are subject to

proof of value and of loss and must be filed in writing. The Claimant hereby warrants that he/she is the absolute owner, or has lawful right to possession of

the property which is the subject matter of this claim. The Claimant further agrees to indemnify and hold harmless Spirit Airlines, its agents and employees,

from and against any and all claims, actions or suits instituted by any other person with respect to said property. Claimant understands that loss may be

reported to the Federal Bureau of Investigations, which has investigative jurisdiction under federal criminal statutes relating to theft or embezzlement of

property from a shipment in interstate or foreign commerce. Spirit Airlines does investigate those claims having validity or item variances. Our security office

also coordinates with federal officials of both investigative and enforcement agencies in the investigation of claims of questionable validity or containing

drugs, firearms, large amounts of jewelry or other expensive items. Spirit Airlines avails itself of any and all investigative measures, including but not limited to

criminal record checks, credit search, etc., in order to validate claim information.

I hereby certify that the foregoing statement and the information provided herein as well as the information contained on the accompanying forms or

documents are accurate, complete, and true. I understand that by providing any information that is, or could be reasonably construed as false and/or

misleading, will result in the denial of my claim in its entirety.

NOTE: NOTARY NOT REQUIRED FOR NON-U.S. RESIDENTS

I do hereby warrant that the foregoing information supplied by me is true,

The signer of the foregoing statement has personally appeared before me

complete and correct, and that I have read and understand the notices set

and has sworn or affirmed the truth of same. Witness my hand and official

forth above. I hereby make a claim against Spirit Airlines.

seal.

In the amount of $________ for a loss occurring on __________, 20____.