Delay Compensation Form

Salutation * Choose ... Mr. Mrs.

First name *

Surname *

Address *

City *

Zip code *

Country *

E-mail *

Confirm e-mail *

Account holder *

Account number / IBAN *

Swift / BIC / Other bank identification code *

Bank name *

Routing number (or similar)

Pass number *

Price *

Currency * Choose ... Albania LekAfghanistan AfghaniArgentina PesoAruba GuilderAustralia DollarAzerbaijan New ManatBahamas DollarBarbados DollarBangladeshi takaBelarus RubleBelize DollarBermuda DollarBolivia BolivianoBosnia and Herzegovina Convertible MarkaBotswana PulaBulgaria LevBrazil RealBrunei Darussalam DollarCambodia RielCanada DollarCayman Islands DollarChile PesoChina Yuan RenminbiColombia PesoCosta Rica ColonCroatia KunaCuba PesoCzech Republic KorunaDenmark KroneDominican Republic PesoEast Caribbean DollarEgypt PoundEl Salvador ColonEstonia KroonEuroFalkland Islands (Malvinas) PoundFiji DollarGhana CedisGibraltar PoundGuatemala QuetzalGuernsey PoundGuyana DollarHonduras LempiraHong Kong DollarHungary ForintIceland KronaIndia RupeeIndonesia RupiahIran RialIsle of Man PoundIsrael ShekelJamaica DollarJapan YenJersey PoundKazakhstan TengeKorea (North) WonKorea (South) WonKyrgyzstan SomLaos KipLatvia LatLebanon PoundLiberia DollarLithuania LitasMacedonia DenarMalaysia RinggitMauritius RupeeMexico PesoMongolia TughrikMozambique MeticalNamibia DollarNepal RupeeNetherlands Antilles GuilderNew Zealand DollarNicaragua CordobaNigeria NairaNorway KroneOman RialPakistan RupeePanama BalboaParaguay GuaraniPeru Nuevo SolPhilippines PesoPoland ZlotyQatar RiyalRomania New LeuRussia RubleSaint Helena PoundSaudi Arabia RiyalSerbia DinarSeychelles RupeeSingapore DollarSolomon Islands DollarSomalia ShillingSouth Africa RandSri Lanka RupeeSweden KronaSwitzerland FrancSuriname DollarSyria PoundTaiwan New DollarThailand BahtTrinidad and Tobago DollarTurkey LiraTurkey LiraTuvalu DollarUkraine HryvnaUnited Kingdom PoundUnited States DollarUruguay PesoUzbekistan SomVenezuela BolivarViet Nam DongYemen RialZimbabwe Dollar

Pass type * Choose ... Eurail Global Pass Eurail One Country Pass Interrail Global Pass Interrail One Country Pass Other

Pass validity * Choose ... 3 days in 1 month 4 days in 1 month 5 days in 1 month 6 days in 1 month 7 days in 1 month 8 days in 1 month 10 days in 2 months 15 days in 2 months 15 days continuous 22 days continuous 1 month continuous 2 months continuous 3 months continuous

Attachment of scanned copy (photo) of the pass & Travel diary

Attachement of any supporting documentation