AIR PASSENGER RIGHTS
(TE DREJTAT AJRORE TE PASAGJEREVE)

EU COMPLAINT FORM
(FORMULAR I ANKIMIMIT)	

THIS FORM CAN BE USED TO LODGE A COMPLAINT WITH AN AIRLINE AND/OR A NATIONAL ENFORCEMENT BODY.
KY FORMULAR MUND TE PERDORET PER TE PARAQITUR NJE ANKESE PER NJE KOMPANI AJRORE DHE/OSE NJE ORGAN KOMBETAR ZBATUES.

Passenger rights in case of
denied boarding, downgrading, cancellation or long delay of their flight under Regulation (EC) 261/2004 and Ministry Order Nr. 1, on February 26, 2013
Te drejtat e pasagjereve ne rast mospranimi ne bord, ulje e kategorise se sherbimit, anullimi ose pritje e gjate e fluturimit sipas Rregullores (EC) 261/2004 dhe Udhezimit Nr. 1, date 26 Shkurt 2013

INSTRUCTIONS
(UDHEZIME)
1)	Passengers who believe they have a valid complaint against an airline regarding denied boarding, downgrading, cancellation or long delay to a given flight should first submit such a complaint to the airline operating the flight concerned. This form may be used for that purpose. Please keep a copy of this form for your records.
(Pasagjeret te cilet besojne se kane nje ankese te vlefshme kunder nje kompanie ajrore lidhur me mospranimin ne bord, uljen e kategorise se sherbimit, anullimin ose pritjen e gjate te nje fluturimi te dhene, duhet se pari te paraqesin nje ankese ne kompanine ajrore qe operon fluturimin ne fjale. Ky formular mund te perdoret per kete qellim. Ju lutemi mbani nje kopje te ketij formulari per te dhenat tuaja.)

2)	Should the airline fail to provide you with a reply within 6 weeks of receipt or, if you are not satisfied with their reply, this form (a copy of the original form sent to the airline may be used) should be sent to the national enforcement body in the Member State where the incident took place.
(Nese kompania ajrore deshton per te te siguruar nje pergjigje brenda 6 javeve nga marrja e ankeses, ose nese ju nuk jeni te kenaqur me pergjigjen e tyre, ky formular (mund te perdoret nje kopje e formularit original derguar linjes ajrore) duhet te dergohet ne organet kombetare te zbatimit ne Shtetin Anetar ku ka ndodhur incidenti.)

3)	If the incident took place at an airport of departure outside the EU, you may contact the national enforcement body in the Member State of flight destination.
(Nese incidenti ka ndodhur ne nje aeroport nisjeje jashte BE, ju mund te kontaktoni organin kombetar te zbatimit ne Shtetin Anetar te destinacionit te fluturimit.)

4)	This complaint form is to be used only for cases concerned with denied boarding incident, downgrading, cancellation, or long delay of a flight.
(Ky formular ankimimi duhet te perdoret vetem per rastet ne fjale si incidentet ne rast mospranimi ne bord, ulje e kategorise se sherbimit, anullimi ose pritje e gjate e fluturimit.)

5)	For any other complaint types such as baggage claims, flight schedule changes made more than 14 days in advance of your travel date or ticketing issues, these too should be submitted first to the airline concerned. Should you not receive a reply, or if you are not satisfied with the reply, the European Consumer Centres in any Member State of the EU can be contacted for further advice.
(Per llojet e tjera te ankimimit si kerkesat per bagazhet, ndryshimet ne orarin e fluturimit te bera ne me shume se 14 dite ne avance te dates se udhetimit tuaj, ose ceshtjet e 
biletave, duhet gjithashtu t’i dorezohen se pari kompanise ajrore ne fjale. Nese nuk merrni nje pergjigje, ose nuk jeni te kenaqur me pergjigjen, Qendra Europiane e Konsumatorit ne cdo shtet anetar te BE mund te kontaktohet per keshilla te metejshme.)

6)	Please fill in the form in block capital letters.
(Ju lutemi plotesoni formularin me shkronja te medha kapitale.)	

Complaint submitted by:
Ankesa paraqitet nga:

Name (Emri):	Surname (Mbiemri):
Address (Adresa):
Postcode, city (Kodi postar, qyteti):	Country (Shteti):
E-mail:
Telephone number (Nr telefoni):

Complaint concerning the following flight:
Ankesa lidhur me fluturimin e meposhtem:	

1) Airline (Kompania ajrore):                                                 Flight number (Numri i fluturimit):
2) Ticket number (Nr i biletes):
3) Booking reference (Referenca e prenotimit):
4) Airport of departure (Aeroporti i nisjes):                  Airport of arrival 5)Connecting airport (if any)                                           (Aeroporti i
 (Aeroporti lidhes, nese ka te tille):                                  mberritjes):   
6) Date of your flight (Data e fluturimit tuaj):
7) Scheduled time of departure
(Ora e planifikuar e nisjes):                                        Actual time of departure:
8) Scheduled time of arrival                                           (Ora aktuale e nisjes)
(Ora e planifikuar e mberritjes):                                 Actual time of arrival: 9)Airport(s) where the incident occurred                     (Ora aktuale e mberritjes)
(Aeroporti/et ku ka ndodhur incidenti):

Passenger details for flight detailed above:
        Detajet e pasagjereve per fluturimet e detajuara te mesiperme:

Name of Passenger
(Emri i pasagjerit)	Please indicate if Adult, Child or Infant (less than 2 years)
(Ju lutemi percaktoni Te rritur, Femije apo I mitur (me i vogel se 2 vjec))
	Please indicate if special assistance was required
(Ju lutemi percaktoni nese nje asistence e vecante ka qene e nevojshme)	

			

Please carefully read these definitions, and indicate with a cross [X] that which applies to this complaint.
Ju lutemi lexoni me kujdes keto perkufizime, dhe vendosni nje kryq [X], aty ku ka vend per ankese.

7)	‘Long delay’ means when a flight does not depart until after the scheduled departure time by:
‘Vonese e gjate’ do te thote kur nje fluturim nuk do te niset deri pas kohes se planifikuar te nisjes prej:

a.	two or more hours, for flights of up to 1500 km;
(dy ose me shume oresh, per fluturimet e nje largesie prej 1500 km);
b.	three or more hours for intra-EU flights of 1,500 km and longer, or for other flights between 1501 and 3000 km;
(tre ose me shume oresh per fluturimet brenda BE me nje largesi 1500 km ose  me shume, ose per fluturime te tjera midis 1501 dhe 3000 km);
c.	four or more hours, for all other flights.
(kater ose me shume oresh, per te gjitha fluturimet e tjera).

8)	‘Cancellation’ means the non-operation of a flight that was previously planned.
     ‘Anullim’ do te thote mos-realizimi i nje fluturimi qe ishte planifikuar me pare.

9)	‘Denied boarding’ means a refusal by the airline to carry a passengers on a flight on which they hold a confirmed reservation and where have presented themselves for check-in and at the boarding gate not later than the time advised by the airline, tour operator or travel agent (if no time was indicated, not later than 45 minutes before the scheduled departure time). This does not include situations where the airline or its agent has reasonable grounds to deny passengers boarding, such as reasons of health, safety, and/or security, or in cases of inadequate travel documentation.
‘Mospranim ne bord’ do te thote nje refuzim nga nje kompani ajrore per te transportuar nje pasagjer ne nje fluturim ku ai ka kryer nje rezervim te konfirmuar dhe eshte paraqitur per check-in ne porten e caktuar jo me vone se ora e keshilluar nga kompania ajrore, operatori i udhetimit ose agjenti i udhetimit (nese nuk eshte treguar asnje ore, jo me vone se 45 minuta perpara ores se planifikuar te nisjes). Ketu nuk perfshihen situatat ku nje linje ajrore ose agjenti i linjes, kane baza te arsyeshme per te mohuar nisjen e pasagjereve, si arsye shendetesore, safety dhe ose sigurie, ose ne rastet e dokumentacionit te pamjaftueshem te udhetimit.

10)	‘Downgrading’ means the passenger involuntarily travelled in a class of service lower than the class of service for which they had a confirmed reservation.
‘Ulje e kategorise se sherbimit’ do te thote qe pasagjeri ne menyre te pavullnetshme udheton ne nje klase me te ulet sherbimi se sa klasa e sherbimit ku ka kryer rezervimin e konfirmuar.

Did the passenger(s) hold a confirmed reservation on the flight concerned?
A ka/ kane mbajtur pasagjeri/et nje rezervim te konfirmuar te fluturimit ne fjale?
•	YES (PO)
•	NO (JO)

Did the passenger(s) present themselves at the check-in desk at the latest at the time indicated by the airline (or if no time was indicated: not later than 45 minutes before the published departure time of the flight)?
A paraqitet/n pasagjeri/et tek sporteli i kontrollit te biletave ne minuten e fundit te dhene nga kompania ajrore (ose nese nuk ka kohe te dhene: jo me shume se 45 minuta perpara ores se publikuar te nisjes se fluturimit)?
•	YES (PO)
•	NO (JO)
Did the passenger(s) present themselves at the boarding gate before the time indicated on the boarding card?
A paraqitet/n pasagjeri/et ne porten e nisjes perpara ores se shenuar ne boarding card?

•	YES (PO)
•	NO (JO)

Did the airline provide the passenger(s) with information on their rights?
A u siguron kompania ajrore pasagjerit/eve informacion per te drejtat e tyre?

•	YES (PO)
•	NO (JO)

I hereby declare that all of the information provided in this form is true and accurate in all respects and for all the passengers concerned.
Une deklaroj se te gjitha informacionet e dhena ne kete formular jane te verteta dhe te sakta ne te gjitha aspektet dhe per te gjithe pasagjeret ne fjale.

Signature(s) of all adult passengers:
Firma/t e te gjithe pasagjereve adult:

…………….….

IN CASE YOUR FLIGHT WAS DELAYED:
NE RAST SE FLUTURIMI JUAJ VONOHET:

Did you receive assistance from the airline or its agent during your long delay?
A keni marre asistence nga kompania ajrore ose agjenti i saj gjate pritjes se gjate?

•	YES (PO)
What kind of assistance has been provided to you?
Cfare lloji asistence kane siguruar per ju?
•	Meals (Vakte)
•	Refreshments (Pije freskuese)
•	Place of accommodation (hotel or other) (in case the delay resulted in an overnight stay)
(Akomodim (hotel ose te tjera) (ne rast se vonesa rezulton me nje nate qendrim))
•	Transfer between airport and place of accommodation (in case the delay resulted in an overnight stay)
(Transferim nga aeroporti ne vendin e akomodimit (ne rast se vonesa rezulton me nje nate qendrim))
•	Communication facilities (telephone calls, fax or e-mail messages)
(Lehtesira komunikimi (thirrje telefonike, faks ose mesazhe e-maili)
•	Other services (please specify): …………………….
(Sherbime te tjera (ju lutemi specifikoni)): ……………………...
•	NO (JO)

If the delay of your flight was of 3 hours of more after the arrival time originally scheduled, did you receive any financial compensation?
Nese vonesa e fluturimit tuaj ishte tre ore pas ores origjinale te planifikuar te arritjes, a moret kompensim financiar?
•	YES (PO)
Amount: € ………..
Shuma: ALL ……….

•	NO (JO)
If the delay of your flight was longer than 5 hours:
Nese vonesa e fluturimit tuaj ishte me e gjate se 5 ore:

-	Did your flight still serve a purpose?
A sherben ende fluturimi juaj per nje qellim?
•	YES (PO)
•	NO (JO)

-	In case your answer to the previous question is ‘no’ and in case your journey had already commenced: were you offered a seat on a flight back to your first point of departure?
Ne rastin kur pergjigja e pyetjes se mesiperme eshte “JO” dhe ne rast se udhetimi juaj nis: a te eshte ofruar nje vend ne nje fluturim mbrapsht ne piken e pare te nisjes?
•	YES (PO)
•	NO (JO)

-	In case you decided not to continue your journey, were you offered a refund?
Ne rast se ju vendosni te mos vazhdoni udhetimin tuaj, a ju eshte ofruar nje shperblim?
•	YES (PO)
•	for the whole ticket price (per cmimin e plote te biletes)
•	for the non-used flight coupons (per segmentin e udhetimit te pakryer)
•	NO (JO)

IN CASE YOUR FLIGHT WAS CANCELLED BY THE AIRLINE:
  NE RAST SE FLUTURIMI JUAJ ESHTE ANULLUAR NGA LINJA AJRORE:

Were you informed about the fact that your flight was cancelled
A jeni informuar per faktin se fluturimi eshte anulluar

•	after your arrival at the airport ?
pas mberritjes ne aeroport?
•	before you arrived at the airport ?
para mberritjes ne  aeroport?
•	less than 1 week before the planned departure time of your flight?
     me pak se 1 jave perpara ores se planifikuar te nisjes se fluturimit tuaj?
•	between 7 days and 2 weeks before the planned departure time of your flight?
     midis 7 ditesh dhe 2 javesh perpara ores se planifikuar te nisjes se fluturimit tuaj?
•	more than 2 weeks before the original scheduled departure date of your flight?
      me shume se 2 jave perpara dates origjinale te planifikuar te nisjes se fluturimit tuaj?

Were you offered an alternative flight?
A ju eshte ofruar nje fluturim alternativ?
•	YES (PO)
•	NO (JO)

Were you informed about the reason why your flight was cancelled?
A jeni informuar per arsyen se pse fluturimi juaj eshte anulluar?
•	YES (PO)
What was the reason given to you?
Cila ishte arsyeja e dhene?

……………………………………………………..

•	NO (JO)

Did you receive assistance from the airline or its agent at the airport?
A keni marre asistence nga linja ajrore ose agjentet e saj ne aeroport?
•	YES (PO)
What kind of assistance has been provided to you?
Cfare lloj asistence te eshte dhene?
•	Meals (Vakte)
•	Refreshments (Pije freskuese)
•	Place of accommodation (hotel or other) (in case the cancellation resulted in an overnight stay)
    (Akomodim (hotel ose te tjera) (ne rast se anullimi rezulton me nje nate qendrim))
•	Transfer between airport and place of accommodation (in case the cancellation resulted in an overnight stay)
     (Transferim nga aeroporti ne vendin e akomodimit (ne rast se anullimi rezulton me nje nate qendrim))
•	Communication facilities (telephone calls, fax or e-mail messages)
Lehtesira komunikimi (thirrje telefonike, faks ose mesazhe e-maili)
•	Other services (please specify): …………………….
Sherbime te tjera (ju lutem specifikoni): …………………
•	NO (JO)

Did you receive any financial compensation for this cancellation?
A keni marre ndonje kompensim financiar per kete anullim?
•	YES (PO)
Amount: € ………..
Shuma: ALL ……….

•	NO (JO)

Were you offered the choice between a re-fund OR a re-routing to your final destination?
A ju ofrua nje zgjedhje midis nje shperblimi ose nje rruge tjeter per ne destinacionin final?
•	YES (PO)

•	NO
•	
I chose the refund option
Une zgjodha opsionin e shperblimit
•	I was offered a refund for the whole ticket price
Mua me eshte ofruar nje shperblim per cmimin e plote te biletes
•	I was offered a refund for non-used flight coupons [please specify]
Mua me eshte ofruar nje shperblim per segmentin e udhetimit te pakryer [ju lutem specifikoni]
………………………………………………………………………………..
 (JO)

•	I chose the rerouting option:
Une zgjodha opsionin e nje rruge tjeter:
………

•	Only refund was offered
Vetem shperblimi mu ofrua
•	Only re-routing to my final destination was offered [please specify]
Vetem opsioni i nje rruge tjeter ne destinacionin final mu ofrua [ju lutem specifikoni]
………………………………………………………………………………

IN CASE YOU WERE DENIED BOARDING AGAINST YOUR WILL:
NE RAST SE JU NUK JENI PRANUAR NE BORD KUNDREJT VULLNETIT TUAJ:

Did the airline call for volunteers?
A ka kerkuar kompania ajrore per te dal vullnetar?

•	YES (PO)
•	NO (JO)
•	I don’t know (Nuk e di)

Did you volunteer not to board the aircraft?
A keni mohuar vullnetarisht te hipni ne avion?

•	YES (PO)	if so, the questions below do not apply (nese po, pyetjet e meposhtme nuk aplikohen)
•	NO (JO)	in this case, please answer next questions (ne kete rast, ju lutemi pergjigjuni pyetjeve te meposhtme)

Did the airline refuse your boarding for reasons of safety, security, health or inadequate travel documents?
A kane refuzuar linjat ajrore hipjen tuaj ne avion, per shkak te sigurise ajrore, parrezikshmerise, shendetit apo dokumentacionit te pamjaftueshem te udhetimit?

•	YES (PO)
•	NO (JO)
•	I don’t know (Nuk e di)

Did you present yourself at the boarding gate not later than the time indicated on your boarding pass?
A jeni paraqitur ne porten e nisjes jo me vone se ora e dhene ne boarding pass?

•	YES (PO)
•	NO (JO)

Did you receive assistance from the airline or its agent after you were denied boarding?
A keni marre asistence nga linja ajrore ose agjenti i saj pasi ju eshte mohuar hipja ne avion?

•	YES (PO)
What kind of assistance has been provided to you?
                   Cfare lloji asistence ju eshte ofruar?
•	Meals (Vakte)
•	Refreshments (Pije freskuese)
•	Place of accommodation (in case the denied boarding resulted in an overnight stay) 
Akomodim (ne rast se mohimi i hipjes ne avion rezulton me nje nate qendrim)
•	Transfer between airport and place of accommodation (in case the denied boarding resulted in an overnight stay)
Transferim nga aeroporti ne vendin e akomodimit (ne rast se mohimi i hipjes ne avion rezulton me nje nate qendrim)
•	Communication facilities (telephone calls, fax or e-mail messages)
Lehtesira komunikimi (thirrje telefonike, faks ose mesazhe e-maili)
•	Other services (please specify): …………………….
Sherbime te tjera (ju lutem specifikoni): ……………………..
•	NO (JO)

Did you receive any financial compensation after you were denied boarding against your will?
A keni marre ndonje kompensim financiar pasi ju eshte mohuar hipja ne avion kundrejt deshires tuaj?

•	YES (PO)
Amount: € ………..
Shuma: ALL ………..

•	NO (JO)

Were you offered the choice between a re-fund OR a re-routing to your final destination?
A ju eshte ofruar nje zgjedhje midis nje shperblimi ose nje rruge tjeter ne destinacionin final?
•	YES (PO)

•	NO 
•	
I chose the re-fund option
Une zgjodha opsionin e shperblimit
•	I was offered a refund for the whole ticket price
Mua mu ofrua nje shperblim per cmimin e plote te biletes
•	I was offered a refund for non-used flight coupons
Mua mu ofrua nje shperblim per segmentin e udhetimit te pakryer

(JO)

•	I chose the rerouting option:
Une zgjodha opsionin e nje rruge tjeter
………

•	Only refund was offered
Vetem shperblimi mu ofrua

•	Only re-routing to my final destination was offered [please specify]
Vetem opsioni i nje rruge tjeter drejt destinacionit final me eshte ofruar [ju lutem specifikoni]
…………………………………………………………………………………..

IN CASE YOU WERE DOWNGRADED:
NE RAST SE JU ESHTE ULUR NIVELI I SHERBIMIT:

I had a reservation in:
Une kisha nje rezervim ne:

•	First Class (Kategoria e Pare)
•	Business Class (Kategoria e Biznesit)

I actually travelled in:
Une ne te vertete udhetova ne:

•	Business Class (Kategoria e Biznesit)
•	Economy Class (Kategoria Ekonomike)

Did you receive any refund as a consequence of this downgrading?
A keni pranuar ndonje rimbursim si pasoje e kesaj ulje ne nivelin e sherbimit?

•	YES (PO)
Amount (Shuma): €/ ALL ………..

•	NO (JO)

What was the price of your ticket? ……………….
Cili ishte cmimi i biletes tuaj? …………….