Assignment of Rights Form

Passenger Name Flight Details

Fernando ibanez gonzalez SQ - 5219, 2020-03-16

Address Booking
Lombok utara, Gili air pink coco hotel, LRDSLN
Lombok, Indonesia, 83350

I hereby assigns to Instalocate Technologies Private Limited (‘Instalocate’) full ownership and legal title to my claim
(‘Claim’) pursuant to Regulation (EC) 261/04 of the European Parliament and of the Council and the Montreal
Convention 1999 in relation to the above operated flight.

I understand that I will not accept any direct contact or payment from the marketing airline and operating carrier in
pursuant of the Claim.

If the assignment pursuant to this assignment form is declared invalid for any reason, this assignment form will be
considered as ‘Power of Attorney’ granted by me to Instalocate, pursuant to which Instalocate is granted exclusive
power, with full substitution right, to:

1. represent me before the operating carrier of the above mentioned flight in relation to the Claim.
2. represent me before the third parties (including judicial, extra judicial and quasi- judicial), respective courts or
national enforcement bodies for infringements of the passenger rights and undertake all types of negotiations on
my behalf.
3. initiate the information requests and to obtain every information requisite whenever Instalocate may think fit to do
so, in relation to the Claim.
4. share my personal data or information, so collected, directly or indirectly, with the third parties only for processing
the claim, not otherwise.
5. collect and receive payments in relation to Claim in the bank account as established by Instalocate.
6. request the operating carrier not to process my personal data in relation to the Claim pursuant to applicable
personal data protection laws, except only to verify the Claim.
7. employ any other Legal Practitioner authorizing him to exercise the power authorities hereby confirmed on the
Instalocate whenever Instalocate may think fit to do so in relation to the Claim.

Fernando ibanez gonzalez

March 20th 2020

Instalocate Technologies Private Limited (CIN U93090DL2018PTC336103)

Registered Office: C102, UNESCO, I. P. Extension, Delhi, India 110092
claims2@instalocate.com | +91-981-815-2187 | www.instalocate.com