Application for ticket cancellation and refund =e 7 , (full neme im the ticket ) Passport*: (passport seres/number as stated in the ticket for refund) I apply: 1) to cancel the ticket: Cancellation*: © voluntary C) involuntary: (indicate the reason for involuntary refund, for ex. flight cancellation, et.) Reservation code (PNR)*: TIKOMD Ticket number*: 6282471746348 (6 lemers) (13 eumbers, 628¢#¢¢++#¢09) Billnumber*: 545983244832417 (1S eumbers) Date of ticket purchase at the website*: «3» 24 2019 2) to refund the amount paid*: [2 w the bank card used for payment: | $ 10/0 /6 (indicate the last + numbers of the card) D0 other way (in case the bank card used for ticket purchase is not valid any more); (indicate the data required to return, for ex. bank same, account) | hereby accept the terms and conditions stated below and agree to pay charges and fees for ticket cancellation and refund stated by Belavia — Belarusian Airlines. | apply to deduct the requested fees and charges from the amount to be refunded. Application for ticket cancellation and refund must be filled in by: ~ passenger or his/her proxy, if passenger is of full age and legally capable; ~ passenger's legal representative (parents, adoptive parents, guardians or curators), if passenger is minor or legally incapable, Belavia —Belarusian Airlines bears no responsibility for passenger's, his/her proxy’s or legal representative's decision for ticket cancellation and refund; as well as for any disagreement that may arise between him/her and the payer as a consequence of the decision taken. For ticket_cancellution and refund the copies of the following documents must be presented by fix FP + filled in application for ticket cancellation and refund (all the fields marked with «*» are mandatory); * passenger’ 5 passport (photo page) or any other identification document (ifthe passenger applies); > proxys passport (photo page) or any other identification document together with the passenger's letter of attorney (if the passenger's ~ legal representative's Bassport {photo pegc) o¢ any ov identification document together with the document that proves his/her legal status (j ~ confirmation of the invalidity of the benk card aa for ticket purchase (in case the bank card js not valid in the month when the refund is transferred), Belavia Belarusian Airlines has the right to request additional information or documents to take a decision for ticket cancellation and refund, ‘The amount to be refunded is calculated according to the applied fire rules and for the cancelled ticket only. The refund will be carried out in 20 business days once all the necessary documents are received. Belavia —Belarusian Airlines bears no responsibility for possible difference resulted from currency conversion or bank service Mig for money refund. he Application is filled in by*: () passenger 6%) passenger's proxy [1] passenger's @ representative aap aagieta Eo Time*: [OB pate*: «3» 25 20198. SYHH SD ann ES’ If you need any assi H EO p Kup & twenty-four-hour Customer Support Service by phone *. cetinaaiiiadiniiietite fields EFTA00314001