AUTHORITY LETTER

I, Mr./ Ms. ______________________________________________________________________________________________________ , holding passport/ID

number______________________________________________________________________________________ authorize Qatar Airways Q.C.S.C.

to transfer/pay USD 143 as compensation in relation to my file reference # DMM3011881

to Mr./ Ms. __________________________________________________________________________________________________________________________________________

Bank account, holding passport/ID number ____________________________________________________________________________________

I declare that I voluntarily and willingly executed this authorization with full knowledge of my
rights and liabilities.

DATE:

SIGNATURE:

QR/GS/BS/783/V1