旅客運輸申明書

1、旅 客 運 輸 申 明 書Passenger Transportation Declaration本人 ，所持證件名稱及號碼為 ，機票號碼為 。我于 年 月 日乘坐海南航空公司 航班由 出發(fā)（經(jīng)停 ）前往 ，座位號 。I , possess passports / ID card numbers held are ,Ticket number is , I take flight of Hainan Airlines on Date Month Year from to , Seat No. is 本人特此聲明I especially to declare：1海南航空公司及其代理人己提醒我注意

2、，為了保證安全，遵守始發(fā)地、經(jīng)停地、目的地所在國家的法律及其他有關(guān)規(guī)定，必須確保以下情況符合要求Hainan Airlines and the agent have already called my attention ,in order to guarantee safe , observe the laws of departure station, stopover , country where one stays of destination and other relevant regulations, must insure the following requirements

3、：(1) 旅行及有關(guān)證件Travel and relevant certificates： 不能沒有前往國的有效證件。the effective certificate of the destination country. 不能沒有有效的回程或者續(xù)程機票。the effective backward or continue ticket. 不能沒有過境國家所需的所有文件。all required files of the transit country. 旅行證件不能過期或者不符合旅行要求。travel document within period of validity and accor

4、d with the traveling requirement . 不能沒有攜帶本次旅行所需的足夠資金。carry enough fund for traveling. 轉(zhuǎn)機時間不能不符合最短轉(zhuǎn)機時間的要求。time of making a connection have to accord with the demands for shortest time of making a connection .(2) 旅客自身的健康狀況Passenger's own health status： 懷孕期在36周以內(nèi)超過32周的孕婦乘機，必須出示縣、市級或者相當于這一級（如國家二甲級）以

5、上醫(yī)院開具的可乘機證明。More than 32 weeks pregnant woman takes a plane within 36 weeks in period of pregnancy , must show county , it is or equivalent to first grade this (such as country two first rate ) whom the above hospital open can be seized the opportunity to prove to be at city level. 患病或者由于自身健康狀況不穩(wěn)定，必

6、須出示縣、市級或者相當于這一級（如國家二甲級）以上醫(yī)院開具的可乘機證明。Ill or because one's own health status is unstable, must show county , it is or equivalent to first grade this (such as country two first rate ) whom the above hospital open can be seized the opportunity to prove to be at city level. 其他情況Others (3) 并且告知，在旅行開始之

7、前，上述非正規(guī)情況必須加以糾正。And tell , before beginning in travel , informal situation described above must be corrected .2我在考慮所有后果之后，仍然決定按預定計劃乘坐上述航班旅行。I still decide to take flight according to the scheduled plan after considering all consequences .3海南航空公司及其代理人對我己盡到全部提醒的義務，我的此次旅行在自身的健康狀況、旅行證件或者其他必備文件方面若發(fā)生問題，與海

8、南航空公司及其代理人無關(guān)。我同意承擔一切后果，并保證不因此而向海南航空公司及其代理人提出法律訴訟和任何賠償，并且愿意賠償航空公司因本人持有非正規(guī)旅客證件旅行或者其它上述情況而遭受的一切損失。Hainan Airlines and their agent own to do all obligations to remind to me, if the problem takes place in one's own health status , travel document or other indispensable files in my travel once here, h

9、ave nothing to do with airline and agent of Hainan. I agree to bear all consequences , guarantee not to put forward the legal lawsuit and any compensation to airline and agent of Hainan because of this , and would like to compensate for all losses that the airline suffers because of holding the info

10、rmal passenger's certificate travelling or other situations described above in person.在見證下，本人于 年 月 日簽署此文件。Get off witness it is here, I sign this file on Date Month Year .旅客聯(lián)系地址及聯(lián)系方式Passenger's and Contact： 旅客或其監(jiān)護人簽名Signature of Passenger /Guardian： 地面服務經(jīng)辦人簽名Signature of Ground Service Handl

11、er： 航空公司代表簽名Signature of HNA Representative： 說明：1用途：用于特殊旅客自身狀況不穩(wěn)定或者自身原因乘機條件不充分，旅客認識到存在的風險，堅持成行下填寫；或者需要旅客證實其旅行及有關(guān)證件或者其他情況符合始發(fā)地、經(jīng)停地、目的地所在國家的法律及其他有關(guān)規(guī)定時填寫。Purpose: This form should be filled by the special passenger who apply the special care, whose healthiness condition is not steady or fall short of t

12、ransport qualification. Or the passenger should approve whose certificate is2填寫人和填寫要求：由旅客或其監(jiān)護人填寫，航空公司代表（海航基地地面服務值班人員，或者海航駐場代表，或者機長）及地面服務經(jīng)辦人員（值機人員，或者特殊旅客服務人員，或者登機口控制人員）簽字確認。內(nèi)容要詳細、完整、屬實，不能有漏項，字跡工整、頁面清潔，不能隨意涂改。Filling requirement: Filled in by the passenger or his guardian, cosigned for confirmation wi

13、th the representative of airline company (Ground Service Watch of HNA Base, Resident Representative of HNA Base, or Captain) and Ground Service Handler( check-in staff ,special passenger service staff. or boarding gate control )witness. Detailed, intact, true and without skip for contents to fill, w

14、riting carefully and neatly, keep page cleaned and not altered at will.3保管要求：由簽字人員所在部門專人負責保管，定點存放，保存期1年。Keep requirement : Kept by special messenger, preserved by fixed position, one year of shelf life .4本申明書一式三聯(lián)，第一聯(lián)為航空公司代表聯(lián)；第二聯(lián)為始發(fā)站地面服務聯(lián)；第三聯(lián)為旅客聯(lián)。This form is in triplicate: the first sheet is for air

15、lines representative; the second sheet is for ground service department of airport of departure; the third sheet is for passenger.13-6b附表旅客運輸申明書（背面）參考資料下述內(nèi)容僅供航空旅行時參考：一、機上條件：1飛機具有密封，增壓客艙的特點。艙內(nèi)氣壓相當于2300公尺（7000英尺）高度的大氣壓力，能引起體腔內(nèi)氣體的膨脹，同時也造成輕度的缺氧狀態(tài)。2飛機在飛行中會有輕微的顛簸及震動。3機上服務人員只受過一般的急救訓練，也不可能更多地照看病人。4機艙內(nèi)的活動范圍

16、和舒適程度受到機艙技術(shù)設備的一定限制。二、具有下列狀況的人，一般不適于航空旅行，需要提供醫(yī)療檢查：1心臟類病患者。處于極嚴重或者危急狀態(tài)的心臟病患者，如嚴重的心力衰竭、呼吸急促、需深度吸氧、面有紫紺癥狀、健康狀況有可能危及自身或者影響其他旅客安全的，或者心肌梗塞（在旅行前六周之內(nèi)增發(fā)生過梗塞）者。2血色素量在50%（Hb8g.dl）以下的貧血人員。3嚴重的中耳炎，伴隨有耳咽管堵塞癥的患者。4近兩周內(nèi)患自發(fā)性氣胸的病人或者做過氣腦造影的神經(jīng)系統(tǒng)病癥的患者。5大縱隔瘤，特大疝腫及腸梗陰的病人。6頭部損傷，顱內(nèi)壓增高及顱骨骨折者；下頜骨骨折最近使用金屬線連接者。7近期進行過外科手術(shù)，傷口未完全愈合者

17、和產(chǎn)婦產(chǎn)后不滿二周者。8在過去30天內(nèi)患過脊髓灰質(zhì)炎的病人；延髓型脊髓灰質(zhì)炎患者。9出生不滿14天的嬰兒。10孕婦。懷孕期在36周以內(nèi)超過32周的孕婦乘機，需具有醫(yī)生在72小時之內(nèi)簽署的診斷證明書。11年事較高旅客。一般老年人下肢靜脈血液回流不好，高空飛行會給老年人帶來一定的不適并有可能帶來身體損害。12其他不適于航空旅行的患病旅客。如冠心病、高血壓、糖尿病、心腦血管病、哮喘等患者。三、海航拒絕運輸?shù)穆每停?下列傳染病或者疑難病患者：霍亂、傷寒、副傷寒、發(fā)疹性斑疹傷寒、痢疾、天花、猩紅熱、白喉、鼠疫、流行性腦炎、腦膜炎、開放期的肺結(jié)核及其他傳染病。2精神病患者，易于發(fā)發(fā)狂，可能對其他旅客或者自

18、身造成危害者。3健康情況可能危及自身或者影響其他旅客安全者。4旅客不遵守公共民用航空運輸?shù)囊?guī)則，或者不聽從承運人的安排和勸導。四、必須提供診斷證明書的病患（傷）旅客：1擔架旅客；2需要提供飛機上醫(yī)療氧氣的病患旅客；3肢體病傷旅客；4承運人及其代理人懷疑在飛機上需要額外醫(yī)療服務的情況下，才能夠完成所需航程運輸?shù)穆每停?懷孕期超過32周在36周以內(nèi)的孕婦。五、以下人員必須在航班離站48小時以前提出乘機要求，得到海航明確給予承運的答復，并于其航班開始辦理乘機手續(xù)1小時前來到海航或海航代理人柜臺辦理乘機手續(xù)：1擔架旅客；2病患輪椅旅客；3攜帶電池驅(qū)動輪椅的旅客；4旅客攜帶的輪椅或者其他輔助設備的電池為

19、危險品材料，需要海航妥善包裝；5殘疾旅客團隊超過（含）10人以上；6需要機上醫(yī)療氧氣瓶的旅客；7攜帶保育箱旅客。注：如果旅客沒有提前告知海航或沒有在規(guī)定的時間內(nèi)來到值機柜臺辦理乘機手續(xù)，海航盡力安排病殘旅客所要求的服務或設備，但是以不能延誤航班為前提。六：以下病殘旅客必須由旅客提供陪護人員：1無自理能力輪椅旅客；2擔架旅客；3心理疾病并且對發(fā)出的安全指令不能理解或者做出必要反應；4嚴重受傷（或損傷）造成行動不便，不能夠自己單獨完成緊急撤離；5聽力或者視力嚴重損傷旅客。注：陪護人員必須是成人且有自主能力，可協(xié)助病殘旅客如廁、緊急撤離及登機、下機，必須全程陪同，須熟悉病患病情并提供相關(guān)幫助，不可有

20、其他任務（如照顧兒童），能夠勝任處理病患旅客機上醫(yī)療需要。七、其他：1患有疾病的旅客，如果乘機過程隱瞞病情所造成的后果，海航不承擔責任。2未按上述要求辦理運輸手續(xù)的，海航不承擔相關(guān)責任。ReferencesThe following contents are only for reference in air travel:I. Conditions on board 1. The airplane's cabin is sealed and pressurized. Cabin pressure is equivalent to the atmospheric conditions

21、at 2300 meter (7000 ft), which cause expansion of body cavities and mild anaerobic conditions. 2. Great jolt and vibration may be occurred while flying. 3. The crew are only trained for common first aid, and not allowed for patient injection. And, the crew should be in charge of the whole service du

22、ring flight, having no time to attend the patients.4. The space of the cabin and comfortableness of activities are limited due to the technical equipment. II. Those with the following conditions are generally not suitable for air travel. They should have medical examination before boarding:1. The pa

23、tient suffering from cardiopathy. The cardiopath is of severe case or in critical status, e.g. severe heart failure, tachypnea, requiring deeply inhaling oxygen, with facial cyanosis, and the health conditions may endanger himself or influence others, or myocardial infarction (The case of myocardial

24、 infarction occurred within six weeks before traveling).2. The person suffering from anemia with hematochrome level below 50% (Hb 8.0 g.dL)3. The patient suffering from severe tympanitis with obstruction of eustachian tubes. 4.The patient suffering from spontaneous pneumothorax within past two weeks

25、 or received pneumoencephalography (PEG) of the nervous system. 5. The patient suffering from mediastinum tumour, serious hernia and intestinal obstruction.6. The patient suffering from head injury, intracranial hypertension and fracture of skull; and fracture of mandible joined with wire recently.7

26、. The patient who have received a surgery operation recently, but the wound hasn't been healed up completely; and it is not exceeding two weeks after delivery for the parturient.8. The patient has suffered from poliomyelitic or bulbar poliomyelitis within past 30 days.9. The infant under 14-day

27、age10. Pregnant woman. The pregnant woman whose pregnancy exceeding 32 weeks. (If the pregnant woman, whose pregnancy is more than 32 weeks but not exceeding 36 weeks, wants to take airplane, it requires her to offer a physician's signed certificate of diagnosis dated within 72-hour before depar

28、ture.) 11. The old passenger. Generally speaking, the high altitude flight may be uncomfortable to the old passengers and even cause harm to them, because of poor venous blood circulation of the lower limbs.12. The other patients who are not suitable for air travel, such as the patients suffering fr

29、om coronary heart disease, hypertension, diabetes, cardiovascular disease, cerebrovascular disease and asthma.III. HNA refuses to transport the following passengers:1. Those suffering from the following infectious diseases or complicated diseases cholera, typhoid fever, paratyphoid fever, typhus, dy

30、sentery, smallpox, scarlatina, diphtheria, plague, epidemic encephalitis, meningitis, open tuberculosis and other infectious diseases. 2. The psychotic, easy out of mind that may cause danger to other passengers or itself.3. The health conditions may endanger himself or influence the safety of other

31、s.4. Those passengers who dont abide by the rules of public civil air transportation, or dont obey the carrier's arrangement and advice. IV. The sick (wounded) passengers must provide "Certificate of Diagnosis":1.The stretcher passenger; 2.The sick passenger may require extra therapeut

32、ic oxygen during flight; 3. The passenger with sick or wounded limbs; 4. For those passengers are doubted that they can take the flight only under the conditions of medical service by carrier and its agent; 5. The pregnant woman whose pregnancy exceeds 32 weeks but less than 36 weeks V. The followin

33、g personnel are required to submit application for emplaning at least 48 hours before departure. After receiving the approval from HNA, they must check-in at the counter of HNA or the Agent of HNA one hour prior to the scheduled departure time. 1. The stretcher passenger; 2. Wheelchair sick passenge

34、r; 3. Passenger carrying battery-powered wheelchair; 4. The batteries of wheelchair or other auxiliary equipment are dangerous materials, which need to be well wrapped by HNA; 5. The number of a disabled passengers' group exceeds (includes) 10 people; 6. Those passengers may require therapeutic

35、bottled oxygen during flight; 7.The passenger carrying incubators. Note: If passenger doesn't give an advance notice to HNA or cant check-in within the scheduled time, HNA will try its best to arrange the related service or equipment required by sick and disable passengers, but subject to no delay of the flight.VI. The following sick or disable passengers must provide accompanied personnel. 1. Wheelchair passenger without self-servicing ability； 2. Stretcher passenger; 3. The passenger suffering fro