Before we get started...

Are you filling this out for yourself?

Representative's Information

Did you file a claim with the airline?

You should totally file with the airline

Property or Injury Details

Is your claim related to property damage or an injury?

Are you the owner of the property?

Owner's Info

What kind of property was it?

Describe the property and the extent of the damage

Describe the extent of the injury



Describe the circumstances and details around the injury or damage

Did you see the incident happen?

In a passenger screening area?

Did someone else see it happen?

Do you have accident insurance?

Accident Insurance Company's Information

Did you file a claim with this insurer?

What type of coverage do you have?

How much is the deductible?


What actions has your insurance provider taken?

Do you have public liability insurance?

Flight & Baggage

Was the property damaged in your checked baggage?

Baggage Tag Number

Was your Checked Baggage Delayed?

How long?

Was your baggage handled by anyone else?

For example: A Skycap, Porter, or other third party service

Flight Itinerary

Was the trip official business for either the military or USA federal government?


Why do you think the TSA was responsible?

Personal Info



Type of Employment

Martial Status


Image Upload

Add images such an official estimate of the claim amount, the original receipt from the purchase of the damaged item, or the damaged product itself


Type your name in all capital letters in between forward slashes, e.g. /GEORGE WASHINGTON/

Created by @AustinHutchison