Fillable Travel Companion Form - Dgs Pass (Page 2 of 3) in pdf

4 – Employee’s Signature

Signature required or form will be returned

I certify that I have advised my travel companion that companion travel is subject to rules and regulations

governing non revenue travel, including dress code and conduct requirements. I have specifically advised my

travel companion that all travel is on a space available basis, regardless of any amount paid for the travel

companion pass.

I understand that I am responsible for my travel companion’s conduct while traveling on a travel companion pass

and that the failure of my travel companion to comply with any rules or regulations governing pass travel, as

outlined in Delta Air Lines’ HR Pass Policy, including dress code and conduct requirements, can result in the

suspension or termination of my travel privileges as well as those of my travel companion and may also result in

disciplinary action regarding my employment up to and including termination.

I understand that there must be a resubmission of this form to reinstate spouse travel benefits at the pass

anniversary date. Terminating a travel companion does not automatically reinstate my spouse.

As with spouse and dependent travel, companion travel is governed by Delta’s rules and regulations and no

court awarded travel companions will be permitted.

I also certify that the information provided with respect to myself and my travel companion is true and correct. I

am aware that the information provided is subject to verification and falsifying this information can lead to

termination of my and my travel companion’s non-revenue travel privileges and recovery of the value of

improperly provided travel.

To the extent that my travel companion exceeds his/her allotment or if any of the above information is not correct

resulting in the need for a payroll deduction, Delta is authorized to make that deduction, from any wages or

benefits due me, including any payments due upon termination of my employment.

________________________________________________________________________________________

Employee’s Signature

Date

5 – Travel Companion’s Signature

Signature required or form will be returned

I certify that the above information is true and correct. I agree to comply with all rules as they may exist at the

time of travel that may be applicable to non revenue travel in general and companion travel specifically. I

understand companion travel is on a space available basis regardless of any amount paid for the travel

companion pass. Failure to abide by any applicable rule can result in revocation of my companion travel.

________________________________________________________________________________________

Travel Companion’s Signature

Date

Send via Company Mail to:

DGS Pass Coordinator, Dept. 937, ATG

Or send US mail to:

DAL Global Services

Business Process / Dept. 937

980 Virginia Avenue, 4

Floor

Atlanta, GA 30354

Or FAX to:

404-677-1486

Travel Companion Form - Dgs Pass Page 2