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Trip Cancellation ? Delay ? Interruption Claim Form & Claimant's Statement PRIMARY PLAN PARTICIPANT'S INFORMATION: Certificate Number: Name: Date of Birth: / / Home Phone #: () Fax #: () Social Security
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Trip cancellation and delay policies vary by airline. The actual length of time it takes to complete a trip will vary depending on the flight and flight schedule. Additional times may be required as a result of unforeseen circumstances which are beyond our control nor may we notify you of such additional time requirements before your flight. We will not be responsible for the cancellation of your flight due to weather conditions, other unforeseen circumstances beyond our control, or other reasons beyond our reasonable control. These include but are not limited to acts of God, terrorist attacks, fires, strikes, accidents and other labor disputes, strikes, cancellations, delays, acts of war (including acts of terrorism), natural disasters such as earthquakes, and floods, and acts of war (including acts of terrorism), riots, insurrections and civil disturbances. It is important that you notify us right away following a delay or interruption of a trip, or your flight will be considered void. If you cancel your trip, notifying us no earlier than the last day of the trip, you must pay all full fare charges at the time of cancellation including any fees due, or you will be charged all fare surcharges. Please note that travel must be authorized by TripExchange prior to your trip. Please read the complete terms and conditions page for the specific policies applicable to travel to and from the following destinations or click here for all the locations you may travel to in these airports.

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