Indemnity And Waiver Of Liability

Indemnity and Waiver of Liability

This form is to be completed by customers as a declaration of the risk of allergic reaction on exposure to specified organic or non-organic constituents which might be present in

meals (including special diet meals), consumable fluids, air particles or contaminants, or when in contact with surfaces or materials which are part of aircraft passenger cabin

fixtures. ** NOTE** this declaration does NOT substitute for a MEDIF* form if so required for customers with medical conditions or for special dietary meal requests** (SPML).

Customers who have a prior history of extreme or severe allergic reaction must complete and sign this declaration and submit it to the nearest Qatar Airways office* no later than

48 hours in advance of the scheduled departure time of the first flight on their booked travel itinerary with Qatar Airways.

* refer

to Contact Us at

Qatar Airways will take all reasonable measures to remove potential allergens from your flight. However, due to the presence of other customers on-board,

we are unable to gurarantee a cabin environment absolutely free of such allergens.

Notification Details (to be completed in full)

Personal Information

Initial

First Name (s)

Family Name

Date of Birth

Passport Number

Country of Residence

Email

Telephone (Residence)

Mobile

Permanent Address

Emergency Contact Person

Name

Country

Contact Number

Flight Details

Booking Reference

Ticket Number

Flight Date

Flight Number

Route

Cabin

Allergy Passport

Please declare below those items to which the person named in this declaration is known to have a history of hyper allergic reaction:

Food & Fluids

1

2

3

4

5

Other Allergies

1

2

3

4

5

Please specify other precautions (if any):

Yes

No

Will you be travelling with a MEDIF* approval?

Yes

No

Please carry with you the necessary medicines.

Will you be travelling with an Epi-pen?

If Yes, provide E Ticket Number:

Yes

No

Are you travelling with someone else?

Yes

No

Did you order a SPML** (Special Meal)?

Indemnity Declaration: I,_______________________(title, initial and family name and in CAPITALS) holder of Qatar Airways E-Ticket

Number_______________________ hereby indemnify and release Qatar Airways from all liability for medical intervention and/or consequential loss or

damages sustained as a result of exposure to allergens when travelling with Qatar Airways.

Date:_____________

Signature:_______________________

*MEDIF: Medical Information Form

** SPML: Please contact our Reservation Office if you want a special meal