New Zealand
Lost Ticket Indemnity Form Close
* Indicates fields which are mandatory and must be completed
Complete a form for each passenger that has lost their tickets (i.e. one form per person)
Section A - Missing Document Details
Passenger Full Name
Lost Document
Issuing Office Name
Date of Issue Calendar image. Office of Issue IATA Nbr
Original Travel Details - Itinerary Used
Original Travel Details - Itinerary Remaining
Fare Basis Total Ticket Value
Original Form of Payment - Tick applicable box  
Cash Cheque Other (please specify)
Travelcard
Credit Card
Sponsor
(if applicable)
Section B - If Refund Required
Generally, there is a mandatory MINIMUM delay if three months from the date this Indemnity is signed.
Circumstances of loss if known:

When applying for an LTI Refund, complete a refund application with a copy of the LTI form and send to Refunds.
Section C - If Replacement Ticket Issued
Replacement Ticket
Attach Airline copy of this form to Audit coupon of replacement ticket.
Section D - Indemnity
Applicant Full Name
Permanent Address
Identification Sighted Credit Card     Drivers License     Passport    Other 
Applicable ID No.
(i.e. passport No.)
I hereby undertake and agree: (1) To indemnify and save harmless Air New Zealand, its servants and agents from and against any and all actions, claims, proceedings, costs, losses, damages, charges and expenses brought or incurred by Air New Zealand arising directly or indirectly out of any and all use or misuse by any person in any manner of the Travel Document. (2) To immediately return to Air New Zealand the travel Document in the event of my recovering possession thereof at any time, without in any way operating or attempting to operate thereon. (3) To immediately advise Air New Zealand should it come to my knowledge at any time that another person has possession of the Travel Document.

DATED at     this     day of     20


Applicant Signature ___________________________________________________________


Witness Signature ____________________________________________________________
Send signed LTI Refund Request to:
Refunds, Ground Floor, 152 Fanshawe Street, Air New Zealand, Private Bag 92007, Auckland
DX: CP19098, Attn: Refunds