特殊旅客乘机申请书.doc

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1、特殊旅客( )乘机申请书中国东方航空股份有限公司： 为乘坐中国东方航空股份有限公司下列班机，我愿声明如下：鉴于我个人的健康状况， 在旅途中由此给本人或其他人造成身体上的损害或死亡，完全由我个人承担责任及损失；并保证不向中国东方航空股份有限公司及所属工作人员或代理人要求赔偿或提出诉讼。旅客姓名： 住址(或单位名称)：航班号/日期：始发站：到达站：健康状况：旅客签字： DECLARATION AND RELEASE(PASSENGER)To Office, CEAI, the undersigned, requesting to be carried as a passenger on the f

2、light(s) as specified below, hereby specifically agree that CEA. Its officers, agents, employees and servants shall not be liable for and be held harmless from any and all claims, actions, causes of action, demands, damages, costs and expenses whatsoever sustained and/or brought by myself, my heirs,

3、 executors, administrators, successors and assigns in case of my death or wounding or other bodily injury resulted solely from my state of health, or by third parties due to or resulting because of my state of health, and shall indemnify CEA for any and all claims, actions, causes of action, demands, damages, costs and expenses sustained by CEA due to or as a result of my state of health.Full name of passenger:Address:Flight No(s)./date:From:To:Passengers state of health,(Attach a doctors diagnosis if possible.)passengerssignature: