Special Assistance

* Have you booked a flight only or a package holiday?:

Name of tour operator (if applicable):

PASSENGER INFORMATION

* First name:

* Last name:

* Date of birth:

BOOKING INFORMATION

* Booking reference:

* Outbound departure airport:

* Outbound arrival airport:

* Outbound flight date:

* Outbound flight number:

Inbound departure airport:

Inbound arrival airport:

Inbound flight date:

Inbound flight number:

* Suitable contact number relating to this assistance request :

* Email address:

* Street and House No:

* Town/City:

* Postcode :

* Country:

SPECIAL ASSISTANCE SERVICE

* Will you require assistance at the airport?:

MOBILITY DEVICE

* Will you be travelling with a wheelchair or mobility device (excluding walking sticks and/or crutches)?:

What type of mobility device will you be taking, e.g. wheelchair, mobility scooter, etc? (if applicable):

Is it collapsible?:

Is it manually powered or electrically powered?:

Please provide all measurements in centimeters:

Height x Width x Depth in centimeters

Please provide weight of mobility device in kgs:

For Electrically powered devices - Can the battery be removed from the wheelchair?:

For Electrically powered devices - How many WATT hours does the battery have?:

For Electrically powered devices - Please provide the make and model of your electric mobility aid.:

Mobility Devices Disclaimer

I have read and understood the requirements regarding travelling with my mobility device. My mobility devices complies with the mentioned requirements. I am aware that the transport of the mobility device can be denied if these requirements are not met.

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