Questionnaire for Deceased Passengers

QUESTIONNAIRE COMPLETED ON BEHALF OF DECEASED VICTIMS

This questionnaire is for a person who is representing an individual who was tragically killed in the event of a crash. It is for the purpose of instruction the lawyers representing the estate of that person in a compensation claim. This questionnaire should be completed by a person who is representing the estate of the deceased passenger.

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Name of Person Completing this form*

Relationship to Deceased*

Deceased

Deceased Name*

First Name Last Name

Deceased Date of Birth*

Deceased Age*

Deceased address at the time of their death?*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Deceased highest level of education or professional qualifications?*

Deceased seated number (if known)*

Please provide details of where the deceased was seated on the aircraft.

Where did the deceased purchase their plane ticket from?*

Please provide details of either online, travel agents and what country they were in when the ticket was purchased.

Was the deceased passenger travelling with anyone else?*

Please provide details of name and relationship to the deceased

Was the deceased married?*

Yes

Divorced

Other

Did the deceased have any dependent children?*

Please provide names and ages