Divisione Passeggeri Regionale
Commerciale Regionale
SPACE FOR USE BY OFFICE STAFF ONLY
TICKET OFFICE AT ____________________________________________
RUBBER STAMP___________________
APPLICATION FOR:
REFUND COMPENSATION DUE TO DELAY
HOW TO FILL IN APPLICATION
Dear Customer,
In order to understand the General Terms and Conditions and procedures entailed in filling in this application, please refer to Trenitalia Regulations .
The full terms and conditions applied regarding applications are laid down in "Trenitalia
General Terms and Conditions for Passenger Carriage - Part III – Regional Transport ”, available online at www.trenitalia.com under the section entitled “ Terms and Conditions for Transport”.
Please also read the terms and conditions laid down in Article 13, Italian Legislative Decree 196 of 30 June 2003 concerning the protection of privacy.
INFORMATION PURSUANT TO ARTICLE 13, Italian Legislative Decree 196 of 30 June 2003
We would like to inform you that, pursuant to Article 13, Italian Legislative Decree 196 of 30 June 2003 "Code for the
Protection of Personal Details", the personal details required on this form shall be processed by our Company solely for purposes strictly related to managing your application. You are requested to provide this information to ensure you can be notified of any issues with payment of your refund by phone and email.
Procedure adopted: your information will be processed in hard and electronic format using manual and computerised tools adopting the measures required to ensure its security and confidentiality and for the amount of time strictly necessary for this purpose, unless a longer period is otherwise established by the law. Your information will not be given to other subjects or otherwise diffused and will only be known to the Regional Office of the Passenger Division in the Area in question as data supervisor and the subjects appointed as responsible for processing by such supervisor.
Data Controller and Data Supervisor: Trenitalia S.p.A. with registered office at 1 Piazza della Croce Rossa, 00161 Rome is
Data Controller.
The Regional Office Director responsible for the Area in which relative service was provided is the Supervisor for data relating to Regional Passenger carriage tickets.
The address of each Regional Office is provided on this form.
Your rights: with respect to the Data Supervisor, you are entitled at any time to exercise your rights pursuant to Article 7,
Italian Legislative Decree 196/03, including the right to: receive confirmation of the existence of information concerning you and description of the relative content and origin, check the accuracy of any information or request integration, update or amendment to such information; request any information processed in breach of the law to be cancelled, transformed into anonymous form or blocked; oppose processing of your information for legitimate reasons.

Divisione Passeggeri Regionale
Commerciale Regionale
CONSENT FOR PROCESSING OF PERSONAL DETAILS
Pursuant to Article 13 of Italian Legislative Decree 196/03, in relation to that laid down in this communication and specifically with regard to processing my personal details for the purpose of receiving notification of any issues concerning my application :
I authorise
I do not authorise
In relation to using my email address and telephone number to receive notifications concerning issues with my application
I authorise
I do not authorise
Date / / Customer signature d d m m y y
TYPE OF APPLICATION
Please select one only (Refund, Compensation due to delay)
REFUND
Indicate reason: a Passenger decides not to travel (prior to train departure) b Departure delayed by at least 60 minutes c
Train cancelled by order of Public Authorities or due to reasons attributable to Ferrovie dello Stato Italiane (including strikes) d Forecast for delayed arrival exceeding 60 minutes e Ticket only partly used
Method of payment: a Bank Transfer b Cheque c Bonus d Kilometer zone Tickets
COMPENSATION FOR DELAYS
Method of payment: a Receipt upon cash payment
Please pick up payment at the ticket office in …………………………………………………..

Divisione Passeggeri Regionale
Commerciale Regionale
TRAVEL DETAILS
COUPON NO.
COUPON NO.
Train Travel date
Train Travel date
COUPON NO. Train
PERSONAL AND BANK DETAILS
Travel date d d m m y y d d m m y y
/ / d d m m y y
Surname Name
Address no.
City
Nation post code
Pr.
Tel. e-mail
(for payments via bank transfer only)
IBAN
(for residents abroad only)
Bic/Swift/ABA

Divisione Passeggeri Regionale
Commerciale Regionale
Abruzzo Via E. Ferrari, 1 65124, Pescara
Alto Adige
Basilicata
Calabria
Campania
Via Garibaldi, 3 - Garibaldistr., 3, 39100, Bolzano/Bozen
V.le Marconi, Stazione Potenza Inferiore, 85100,
Potenza
Via Mercalli, 48, 89129, Reggio Calabria
Corso Novara, 10 80143, Napoli
Friuli Venezia Giulia
Emilia
Lazio
Liguria
Marche
Molise
Piedomont
Puglia
Sicily
Sardinia
Tuscany
Trentino
Umbria
Valle d'Aosta
Veneto
P.za Vittorio Veneto, 3, 34132 Trieste
Via del Lazzaretto, 16, 40131, Bologna
Via Prenestina, 41 00176, Roma
Via del Lagaccio, 3, 16134, Genova
Via Einaudi, 1, 60125, Ancona
Via Novelli, 2, 86100, Campobasso
Via Nizza, 8 bis, 10125, Torino
Via Giulio Petroni, 10/b, 70124, Bari
Via Oreto Nuova - Fondo Alfano s.n.c., 90123, Palermo
Viale La Playa 17, 09123, Cagliari
Viale Spartaco Lavagnini, 58, 50129, Firenze
Via Dosso Dossi, 23, 38121, Trento
P.za Vittorio Veneto, Stazione FS, 06124, Perugia
P.za Manzetti, 1, 11100, Aosta
Via Decorati al valor civile, 90, 30171, Venezia Mestre

Divisione Passeggeri Regionale
Commerciale Regionale
FOR USE BY TICKET OFFICE STAFF ONLY
•
Number of tickets attached …………………………………………………………………………………….…………………………………….
• Any other attachments …………………………………………………………………………………………………
FILE REFERENCE NO.*
COUPON NUMBER
COUPON NUMBER
COUPON NUMBER
DATE
/ /
TIME
:
ADDITIONAL NOTES FROM TICKET OFFICE
STAFF ...................................................................................................................................................................................................................
.............................................................................................................................................................................................................................
.......................................................................................................................................................................................................................
RUBBER STAMP
CID Legible signature of ticket office staff member
RECEIPT TO DETACH AND GIVE TO CUSTOMER
TICKET OFFICE AT
FILE REFERENCE NO.*
COUPON NUMBER
COUPON NUMBER
COUPON NUMBER
DATE / /
TIME
:
CID Legible signature of ticket office staff member
RUBBER STAMP
‘*’ Optional.