☐

Delay

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Cancellation

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Missed connection due to a delay or cancellation

2.1.

Date of previous reimbursement/compensation request for same rail journey (day/month/year): …./…./….

2.2.

Request addressed to (please state the name of the railway undertaking – in case several railway undertakings were involved, please mention them all here):

…

2.3.

Means used for this previous request (e.g. online form or mobile app – please indicate the reference of this request, where available):

…

3.1.

Name of railway undertaking

…

3.2.

Scheduled journey

3.2.1.

Departure date (day/month/year): …./…./….

3.2.2.

Departure station:

…

3.2.3.

Destination station:

…

3.2.4.

Scheduled time of departure (hour/minutes): ....:....

3.2.5.

Scheduled time of arrival at destination (hour/minutes): ....:....

3.2.6.

Train No/category of train:

…

3.2.7.

Ticket Number(s)/Booking Reference:

…

3.2.8.

Ticket price(s):

…

3.3.

Actual journey

3.3.1.

Date of actual arrival (day/month/year): …./…./….

3.3.2.

Actual time of departure (hour/minutes): ....:....

3.3.3.

Actual time of arrival at final destination (hour/minutes): ....:....

3.3.4.

Train No/category of train:

…

3.3.5.

Missed connection in (station):

…

☐

Reimbursement from railway undertaking of the ticket(s) (*),(**) due to a cancelled or delayed train or missed connection which would lead to an expected delay at arrival at the final destination of 60 minutes or more.

☐

Compensation from railway undertaking (**) (please select one of the following options)

☐

Reimbursement of the costs from railway undertaking for using other providers of transport services or other costs (bills for other railway undertaking, bus, coach, taxi, hotel or other accommodation, meals, refreshments) (*****).

(1)

you bought a ticket or tickets in a single commercial transaction for a journey including one or more connections;

(2)

it is mentioned on the tickets, or on another (electronic) document, that the tickets represent separate transport contracts;

(3)

you were informed of this prior to purchase.

(*)

(**)

The compensation of the ticket price shall be paid within one month after the submission of the request for compensation. Please note that railway undertakings may introduce a minimum threshold under which payments for compensation will not be paid. This threshold shall not exceed EUR 4 per ticket. In addition, please note that you can apply either for compensation or for reimbursement of the ticket(s) from a railway undertaking, but not both for the same journey.

(***)

(****)

(*****)

—

the ‘Your Europe’ website: www.europa.eu/youreurope/citizens/travel

—

the ‘Your Passenger Rights’ app by scanning the QR code

—

Europe Direct by phone:

00 800 6 7 8 9 10 11

5.1.

Name

5.1.1.

First name: … 5.1.2. Last name: …

5.2.

Address

5.2.1.

Street name: … 5.2.2. No: …

5.2.3.

Country: … 5.2.4. Postal code: … 5.2.5. City/Town: …

5.3.

Contact details

5.3.1.

Email address (where applicable, please mention the address used at the time of booking):

…

5.3.2.

Telephone number:

…

5.4.

Preferred form of payment for reimbursement/compensation (please mark only one box):

5.5.

Payment details

(in case of preference for reimbursement/compensation in money)

5.5.1.

IBAN (account number):

…

5.5.2.

SWIFT/BIC (routing number): …

5.5.3.

Other means of payment used by the passenger to purchase the ticket (e.g. PayPal, Apple pay, etc.):

…

5.5.4.

Name of account holder (first name, last name):

…