INVOLUNTARY DENIED BOARDING COMPENSATION CLAIM

Airline "Bumping" Compensation Demand

PASSENGER INFORMATION

Full Legal Name: [________________________________]

Mailing Address: [________________________________]

City: [________________] State: [____] Zip: [__________]

Phone: [________________________________]

Email: [________________________________]

Frequent Flyer Number (if applicable): [________________________________]

FLIGHT INFORMATION

Airline: [________________________________]

Original Flight Number: [________________________________]

Date of Travel: [__/__/____]

Departure City/Airport: [________________________________]

Destination City/Airport: [________________________________]

Scheduled Departure Time: [________]

Scheduled Arrival Time: [________]

Confirmation Number: [________________________________]

Ticket Number: [________________________________]

Class of Service: ☐ First ☐ Business ☐ Premium Economy ☐ Economy

Fare Paid: $[__________]

One-Way or Round-Trip: ☐ One-Way ☐ Round-Trip

DENIED BOARDING DETAILS

Check-In and Boarding

Time Checked In: [________]

Check-In Method: ☐ Online ☐ Airport Kiosk ☐ Counter ☐ Mobile App

Time Arrived at Gate: [________]

Boarding Pass Received: ☐ Yes ☐ No

Seat Assignment: [________]

Denial of Boarding

Were You Denied Boarding Involuntarily? ☐ Yes ☐ No

Time Denied Boarding: [________]

Location (Gate Number): [________________________________]

Airline Employee Name/ID (if available): [________________________________]

Reason Given for Denial:

☐ Flight oversold
☐ Weight and balance restrictions
☐ Equipment change (smaller aircraft)
☐ No reason provided
☐ Other: [________________________________]

Volunteer Request

Did the Airline Request Volunteers Before Bumping You?

☐ Yes - Compensation offered to volunteers: $[__________] / [________________]
☐ No - Airline did not solicit volunteers before involuntarily bumping passengers

ALTERNATE TRANSPORTATION

Rebooking Information

Were You Offered Alternate Transportation? ☐ Yes ☐ No

Alternate Flight Number: [________________________________]

Alternate Departure Time: [________]

Alternate Arrival Time: [________]

Actual Arrival Time at Final Destination: [________]

Delay Calculation

Scheduled Arrival on Original Flight: [________] on [__/__/____]

Actual Arrival on Alternate Flight: [________] on [__/__/____]

Total Delay: [____] hours [____] minutes

Alternate Transportation Type

☐ Same airline, later flight
☐ Different airline flight
☐ Ground transportation provided (bus, train)
☐ Passenger arranged own transportation
☐ No alternate transportation offered/accepted

COMPENSATION ENTITLEMENT

Regulatory Compensation Amounts (14 CFR 250.5)

(Amounts effective January 22, 2025 - verify current limits)

Domestic Flights:

International Flights:

Your Compensation Calculation

Type of Flight: ☐ Domestic ☐ International

One-Way Fare Amount: $[__________]

Delay Category: ☐ 0-1 hr ☐ 1-2 hr (domestic) / 1-4 hr (intl) ☐ Over 2 hr (domestic) / 4 hr (intl)

Applicable Percentage: ☐ 0% ☐ 200% ☐ 400%

Calculated Compensation:
- One-way fare: $[__________]
- Multiplied by: [____]%
- Equals: $[__________]
- Maximum limit: $[__________]

COMPENSATION OWED: $[__________]

COMPENSATION RECEIVED

At Airport

Did Airline Offer Cash/Check Compensation at Airport?

☐ Yes - Amount: $[__________]
☐ No

Did You Accept the Offer? ☐ Yes ☐ No

Form of Payment Offered:
☐ Cash
☐ Check
☐ Travel voucher/credit
☐ Other: [________________________________]

Written Notice

Did Airline Provide Written Explanation of Denied Boarding Compensation?

☐ Yes (required by 14 CFR 250.9)
☐ No

Deficiency in Compensation

Amount Owed per Regulation: $[__________]

Amount Offered/Received: $[__________]

Deficiency: $[__________]

ADDITIONAL DAMAGES

Out-of-Pocket Expenses Due to Denied Boarding

Ancillary Fees Refund

Per 14 CFR 250.5(e), the airline must refund unused ancillary fees:

TOTAL CLAIM AMOUNT

DEMAND FOR PAYMENT

To: [________________________________] (Airline)

Customer Relations Address:
[________________________________]
[________________________________]
[________________________________]

RE: Involuntary Denied Boarding - Flight [________] on [__/__/____]
Confirmation Number: [________________________________]

Dear Sir/Madam:

On [__/__/____], I held a confirmed reservation on [________________________________] Flight [________] from [________________________________] to [________________________________], scheduled to depart at [________] and arrive at [________].

Despite having a valid confirmed reservation and timely check-in, I was involuntarily denied boarding due to [________________________________].

Pursuant to 14 CFR Part 250, I am entitled to denied boarding compensation in the amount of $[__________], calculated as follows:

• One-way fare: $[__________]
• Applicable multiplier: [____]%
• Compensation: $[__________]
• Maximum limit applied: $[__________]

☐ I was not offered compensation at the airport as required by 14 CFR 250.5(b).

☐ I was offered only $[__________], which is less than the amount required by regulation.

☐ I was offered a travel voucher instead of cash/check compensation.

In addition to the statutory compensation, I incurred the following expenses as a direct result of being denied boarding:

[List expenses: ________________________________]

Total additional expenses: $[__________]

TOTAL AMOUNT DUE: $[__________]

I demand payment of the above amount within 30 days of the date of this letter. Payment should be made by check payable to [________________________________] and mailed to the address above.

If I do not receive satisfactory resolution within 30 days, I will:

1. File a complaint with the Department of Transportation, Aviation Consumer Protection Division
2. Pursue this claim in small claims court
3. Seek additional remedies available under law

Please govern yourself accordingly.

Sincerely,

[________________________________]
Date: [__/__/____]

SUPPORTING DOCUMENTATION CHECKLIST

☐ Copy of original ticket/itinerary
☐ Copy of boarding pass (if received)
☐ Confirmation email
☐ Credit card statement showing fare paid
☐ Written notice from airline (if received)
☐ Photos of gate display showing flight status
☐ Receipts for all out-of-pocket expenses
☐ Alternate flight documentation
☐ Correspondence with airline
☐ Other: [________________________________]

REGULATORY RIGHTS SUMMARY

Your Rights Under 14 CFR Part 250

1. Volunteer Solicitation: Airlines must ask for volunteers before involuntarily bumping passengers.

2. Immediate Payment: Cash/check compensation must be provided at the airport on the day of denied boarding.

3. Written Explanation: Airlines must provide written notice explaining compensation and boarding priorities.

4. No Voucher Requirement: You have the right to cash/check instead of travel vouchers. If offered a voucher, the airline must disclose all restrictions and offer cash as an alternative.

5. Ancillary Refunds: Airlines must refund unused ancillary fees.

Exceptions (When Compensation May Not Apply)

You may not be entitled to compensation if:

☐ You failed to comply with ticketing, check-in, or reconfirmation requirements
☐ You did not meet boarding deadlines
☐ You were denied boarding for safety, health, or security reasons
☐ The flight was operated by an aircraft with fewer than 30 seats
☐ The flight was a charter flight
☐ You were offered a seat in a different class at no additional cost

ESCALATION OPTIONS

If Airline Does Not Respond Satisfactorily:

1. DOT Complaint:
Aviation Consumer Protection Division
U.S. Department of Transportation
Online: airconsumercomplaints.dot.gov
Phone: 202-366-2220

2. Small Claims Court:
Jurisdiction: [________________________________]
Filing Fee: $[________] (varies by jurisdiction)
Claim Limit: $[__________] (varies by jurisdiction)

3. Credit Card Dispute:
If paid by credit card, consider dispute for services not rendered.

CERTIFICATION

I certify that the information provided in this claim is true and accurate to the best of my knowledge.

Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

This template is for informational purposes only and does not constitute legal advice. Compensation limits are adjusted periodically. Verify current amounts with the Department of Transportation. For claims involving international flights or EU carriers, additional regulations may apply.