Letter of Declaration
Passenger Name: __________________________________________________________________________________________
Ticket No. to be refunded: ___________________________________________________________________________________
Substitute Ticket(Or Lost Ticket No.) No.:_______________________________________________________________________
I, the undersigned, hereby apply for ticket refund, required to check any of the following declaration in compliance with China
Airlines Refund Policy on account of the incompletion of attached tickets, papers and/or documents, and declare that should
there be any legal liability, or property and/or non-property damage caused, I will bear all consequences. Furthermore, I
unconditionally refund the overpayment caused by duplicated refund application.
Check the following declaration if applicable□ 1. I acknowledge and agree that agent commission should be deducted from refund value should tickets be purchased via
travel agency.
□ 2. I acknowledge and agree that residual value of tickets should be refunded to travel agency’s original form of payment(including voucher) should tickets be purchased via travel agency.
□ 3. Request to keep original boarding pass in the application of fare difference refund of down-grade.
□ 4. Receive refund with copy of ticket receipt under the condition of loss of original copy.
□ 5. I acknowledge and agree that 3% bank transaction fee should be deducted from refund value when requested form ofrefund is cash or check should tickets be paid by credit card.
□ 6. I acknowledge and agree that residual value of tickets should be refunded to my credit account as below______________________________________________________________________________________________________□ 7. Other conditions: __________________________________________________________________________________
This letter is signed to China Airlines, Limited.
Signature of Agent:__________________________ Signature of Principal:__________________________________________
Tel No:____________________________________ ID No./Passport No.:_____________________________
Tel No.:________________________________________
Stamp of Travel Agency:_______________

Address:_________________________________________________________

Attached certificates/documents: □Copy of Passport □Copy of ID □Copy of driver’s license
The applicant consents to the latest Privacy Protection Policy and Statement on the official websites of China Airlines andMandarin Airlines. Personal data (such as name, contact information, account information, copy of ID card, copy of passport,copy of driver's license, etc.) provided in the refund application and accompanying documents, is solely for the purpose ofrefund processing by China Airlines and Mandarin Airlines. Both airlines undertake not to disclose the personal data to any third
party unrelated to the provided services or transactions. Data subjects are assured the right to exercise legal rights over theirpersonal data, including inquiry, supplementation, correction, and deletion. For refund processing and necessary business
operations, China Airlines and Mandarin Airlines will retain data subjects’ personal data for a required duration. Once thesepurposes are no longer applicable, both airlines will securely destroy the personal data within the designated time frame, using
commercially reasonable and technically feasible measures in compliance with relevant laws to prevent recovery or duplication.
I have thoroughly read and agree to all the stated terms and conditions.

F-QT-025

Version: AB