海南航空特殊旅客服务需求单(A 类--正面)

为方便旅客旅行，海南航空公司特制订此申请表，申请表中列明航空公司为特殊旅客提供的简单服务项目。该服务项目包括轮椅服务、引导服务、客舱特殊餐食服务等，服务项目免费，不需要旅客提供适宜乘机的医疗诊断证明。

当您电话订票，或在售票处买票时，请参照此表背面内容，提出您的需求。根据您提供的需求信息，海航航空公司提前做出妥善安排，为您提供周到服务。您可以不用填写此表，是否填写遵循您的意愿。如果您想了解更多细节，请联系海航95339或距您最近的海航售票处。

特殊服务内容描述如下，仅供参考，具体见背面。

引导服务

海南航空公司可为您提供引导服务，帮助您办理乘机手续，托运行李，协助您通过安全检查，进入候机厅休息，引导您至登机口登机。飞机到达后，服务人员引导您下机，协助您提取托运行李，护送您至候机楼出口。适用于年长旅客、残疾旅客、孕妇、有语言沟通障碍的旅客（含外籍旅客）等需要海航提供引导服务的旅客。

轮椅服务

如果您需要轮椅服务，请在购票时提出。在机场值机柜台，服务人员会要求您将轮椅办理托运。海航可为您提供特殊轮椅服务，可以进入飞机客舱，到达您的座位旁。如果您打算使用自己的轮椅到达登机门，在购票时，应告知海航。因为飞机客舱内没有可供轮椅存放在空间，您自己的轮椅应在登机门办理托运，放入货舱。适用于行动不便的年长旅客、残疾旅客、病患旅客等需要提供轮椅服务的旅客。

特殊餐食

如果您因为身体原因，飞机餐食上需要特殊照顾。您可以选择特殊餐食，如低热量餐食、无糖餐食等。在不同的季节，在不同的航线上，海航可提供不同的特殊餐食。您可以在购票时咨询海航95339或距您最近的海航售票处，了解最新推出的特殊餐食品种，并进行预定。

客舱婴儿摇篮服务

海航目前提供的婴儿摇篮，可供身高在72厘米以下，体重在11公斤以内，0-2（不含）岁的婴儿使用。此申请仅限在国际航班宽体机执行航班上配备，数量有限，请您订票时向售票员详细咨询。

客舱儿童座椅服务

海航目前提供的儿童座椅，可供身高在71-116（含）厘米，体重在10-25（含）公斤，年龄2-5（含）岁的儿童使用。此申请仅限在国际航班宽体机执行航班上配备，数量有限，请您订票时向售票员详细咨询。

（轮椅旅客（WCHS/WCHR）、听力/视力/语言障碍旅客、年长旅客、孕妇（孕期﹤32周）、携带婴儿旅客、特殊餐食旅客、         ）

尊敬的旅客朋友：

非常感谢您选乘海南航空公司航班，为了给您提供更好的服务，请您详细填写以下内容，在您需要选择的服务项目“□”内打“√”。

姓名 性别 年龄 个 航班日期  航班号  电话 人 A  始发站 经停站  到达站  信证件种类  证件号码 息  地址

身

体 B  状

况 如果您是盲人或聋哑旅客，是否携带导盲犬或助听犬？  否 □    是 □

□ 能上下台阶，但进行长距离移动时需要轮椅帮助（WCHR ）

□ 不能上下台阶，但在客舱中能自己行动（WCHS ）

□ 在值机柜台进行托运;

□ 希望使用自有轮椅到达登机门，在登机门办理

托运;  □ 手动轮椅

□ 机械轴环□ 飞机到达后，希望飞机舱门口提取托运轮椅;

式（WCMP ）□ 飞机到达后，希望在托运行李提取处提取托运轮轮椅;  ⑵ 是否携带自有轮椅旅椅C  * 目前客舱内无法放置旅客自有轮椅，敬请谅解。行？ 服否 □    是 □ □ 携带可溢出液体电池驱动轮椅（WCBW ）;  务 □ 携带密封式无溢出电池驱动轮椅（WCBD ）;

□ 飞机到达后，希望飞机舱门口提取托运轮椅;  □ 电动轮椅 □ 飞机到达后，希望在行李转盘处提取托运轮椅;

* 电动轮椅装入货舱所需时间较长，因此请您于航

班起飞90分钟前到值机柜台进行轮椅托运。

⑶您是否需要客舱轮椅服务？    否 □     是□     目前海南航空仅在B767、A330和A340

机型上提供。

引⑴ 始发地是否需要引导您到达登机口？          否□    是□

导⑵ 中转地是否需要引导您到达中转航班登机区？  否□    是□ D  服如选择“是”，请告知您中转航班号                    起飞时间

务 ⑶ 目的地是否需要引导您至到达厅出口？        否□    是□

⑴ 需要特殊餐食？  否□    是□

如果选“是”，请您向工作人员索要特殊餐食清单，请指定特殊餐食类型：

*因特殊餐食准备受时间限制，请您在航班起飞24小时前提出申请。24小时以内提出的申请，

请联系工作人员，确认是否可以提供此服务。 其E  ⑵ 需要特殊座位？  否□    是□ 他 如果选“是”，请指明：靠近过道座位 □， 靠近窗口座位 □， 其他

⑶ 是否需要客舱婴儿摇篮？   否□    是□    预留座位号：____________

⑷ 是否需要客舱儿童座椅？   否□    是□    预留座位号：____________

⑸ 其他需求________________________________________________________

随姓名：                                                    F  行 电话：

我，即为签字者，保证以上内容真实、有效。    旅客（监护人）签字：                  日期：    海南航空经办单位：                售票处或地面服务单位；经办人签字：              日期：    说明：此单一式四联，无碳式复写。第一联为出票联，由售票处留存；第二联为值机联，始发站值机单位留存；第三联服务联，始发站特殊旅客地面服务人员交至航班乘务长处，乘务长在航班到达后，将此服务联交目的站特殊旅客服务人员留存；第四联为旅客联。 ⑴ 在机场是否需要轮椅服务？  否 □    是 □

注：本单建议采用ISO 标准A4型纸（尺寸：210×297mm）

Special Passenger Service Demand Sheet (Type A)

This application form has been designed to provide better services to passengers. It enumerates free service items available to special passengers including wheelchair services, guidance services, special meal services. Medical information sheet certifying the passenger’s flight-worthiness is not required.

When booking ticket via phone or buying ticket at the ticket counter, passengers should fill out the back of this form where appropriate so that HNA can make appropriate arrangement in advance based on the information provided to ensure thoughtful services. Whether to fill out this application is entirely up to the passengers. For more information, please contact HNA at 95339 or visit the nearest ticket office.

Special services are described below for reference only, see back for detailed information. Guidance services

HNA can provide guidance services to passengers, including assisting passengers to go through check-in procedure, baggage check-in procedure and security check procedure, guiding passengers to the terminal to rest, guiding passengers to the boarding gate, guiding passengers out of the aircraft upon arrival, assisting passengers to retrieve checked baggage, and escorting passengers to the terminal exit..Apply to elder passengers, passengers with disability, passengers having difficulty in communicating (including foreign passengers) and those who need guidance service.

Wheelchair services

Passengers who require wheelchair services should apply at the time of ticket-buying. Service personnel at the airport’s check-in counter will require passengers to go through wheelchair check-in procedure. HNA may provide special wheelchair services to passengers by placing the wheelchair beside the passenger’s seat. If any passenger intends to use his/her own wheelchair up till the boarding gate, s/he should notify HNA at the time of ticket-buying. As there is no space to store wheelchairs in the cabin, passengers who intend to use their own wheelchairs need to go through baggage check-in procedure at the boarding gate and have their wheelchairs stored in the cargo cabin.. Apply to mobility-restricted older passengers, passengers with disability and other passengers physically or mentally impaired needing wheelchair service.

Special Meals

Passengers requiring special meals during the flight due to physical conditions are offered with different choices such as low-calorie meal, sugarless meal, etc. HNA's special meals may vary with different seasons and different routes. Passengers may contact HNA at 95339 or visit the nearest ticket office for latest information on newly-launched special meals and make reservation at the time of ticket-buying.

Infant cradle service:

HNA provide infant cradles to those infants whose height is within 72cm and the weight is within the 11kg and the age is between 0 to 2 yeas old. The facility is only equipped on international flight taken by wide-body aircraft.The amount of infant cradles on each aircraft of HNA is limited , passengers shall consult with the ticket seller when booking tickets.

Child seat service

HNA provide child seat to those children whose height is between 70cm to 116cm (inclusion) weight between 10kg to 25kg (inclusion) and the age between 2 to 5 (inclusion) years old. The facility is only equipped on international flight taken by wide-body aircraft.The amount of child seat on each aircraft of HNA is limited, passengers shall consult with the ticket seller when booking.

Special Passenger Service Demand Sheet (Type A—Back) (Wheelchair passengers  (WCHS/WCHR), physically  challenged  passengers,  senior  passengers,  pregnant  passengers  (pregnancy period

Dear  passengers:

Thanks  for  choosing  HNA’s flights.  Please  fill  out  this  form  in  details  by  ticking  items  in  □ so  that  we  can  provide  better  services  to  you.

Name   Sex   Age

Flight  date   Flight  No.   Tel   Personal  A  Starting  Airport   Stop ‐over  airport   Destination   information  Type  of  certificate   Number  of  certificate

Address

Physical  B  condition  For  passengers  with  sight  or  hearing  challenged,  whether  escorted  by  a  seeing  eye  dog  or  hearing  aid  dog?

No  □    Yes  □

⑴ Wheelchair  □ Able  to  go  up  and  down  stairs,  but  need  wheelchair  for  long ‐distance  movement  service  needed  in  (WCHR) the  airport?   □ Unable  to  go  up  and  down  stairs,  but  able  to  move  unassisted  in  the  cabin  (WCHS) No  □   Yes  □

□ Complete  wheelchair  check ‐in  at  the  check ‐in  counter

□ Prefer  to  use  my  own  wheelchair  to  the  boarding  gate  and

complete  wheelchair  check ‐in  at  the  boarding  gate

□ Manual  wheelchair □ Prefer  to  retrieve  the  checked  wheelchair  at  the  cabin  door

□ Mechanical  axle  upon  arrival

wheelchair  (WCMP) □ Prefer  to  retrieve  the  checked  wheelchair  at  the  baggage

claim  area  upon  arrival.

* We  regret  to  inform  you  currently  there  is  no  space  in  the  cabin

to  store  the  passenger’s own  wheelchair.   Wheelchair  ⑵Availability  of  C  services  passenger’s own  □ Travelling  with  a  wheelchair  driven  by  spill ‐able  battery

wheelchair?  (WCBW)

No  □   Yes  □ □ Travelling  with  a  wheelchair  driven  by  sealed  non ‐spill ‐able

battery  (WCBD)

□ Prefer  to  retrieve  the  checked  wheelchair  at  the  cabin  door

□ Electric  wheelchair upon  arrival

□ Prefer  to  retrieve  the  checked  wheelchair  at  the  baggage

claim  area  upon  arrival.

* It  takes  a  relatively  long  time  to  load  the  electric  wheelchair  in

the  cargo  cabin,  so  please  complete  wheelchair  check ‐in  at  the

check ‐in  counter  90 minutes  before  the  departure  time.

⑶DO  you  need  on ‐board  wheelchair  service  ?   No  □   Yes  □

*Hainan airlines  can  provide  you  with  on ‐board  wheelchair  services  in  767&A330$A340aircraft cabin  .

⑴Guiding  service  till  the  boarding  gate  required  at  the  departure  airport?    No  □    Yes  □

Guidance  ⑵ Guiding  service  till  the  boarding  area  required  at  the  transit  airport?      No  □    Yes  □ D  services  If  yes,  please  indicate  transit  flight  number  ______ and  departure  time________.

⑶Guiding  service  to  the  arrival  hall  exit  upon  arrival  required?             No  □    Yes  □

⑴ Special  meal  required?     No  □    Yes  □

If  “yes”, please  ask  the  staff  for  special  meal  menu  and  specify  which  kind  of  special  meal  is  needed             *As special  meal  requires  prior  preparation,  please  submit  application  to  our  staff  24 hours  before  flight  SPECIAL  departure  for  confirmation.   IN ‐FLIGHT  ⑵Special  seat  required        No  □    Yes  □           E  ARRANGEMEN If  "yes",  please  specify: aisle  seat   □,  window  seat  □,  other                                        TS  NEED  ⑶ Bassinet  required?         No  □    Yes  □  Seats  No.:___________

⑷ Child  seat  required?        No  □    Yes  □  Seats  No.:____________

⑸ Other  requirements

Name:                                                                                      F  Retinue  Telephone:

I,  the  undersigned,  hereby  guarantee  the  above  information  is  authentic  and  valid.

Signature  of  passenger  (guardian)

HNA’s department  handling  the  application: office  or  ground  service  department;  Handled  by:Date

① This  application  form  does  not  apply  to  unaccompanied  minor.  Unaccompanied  minor  should  use  Special  Passenger  Service  Demand  Sheet  (Type B)  ② This  application  form  does  not  apply  to  passengers  who  need  certain  medical  equipment  (e.g. oxygen  cylinder)  or  stretcher  during  the  flight  for  medical  care  purposes,  passengers  who  can  not  take  care  of  their  own  needs  unassisted,  passengers  on  wheelchairs,  passengers  who  need  assistance  sitting  down  or  getting  up  (WCHC), passengers  suffering  from  certain  disease,  and  healthy  passengers  who  have  been  pregnant  for  more  than  8 months  (32 weeks)  (inclusive) but  less  than  9 months  (36 weeks).  Special  Passenger  Service  Demand  Sheet  (Type C)  shall  apply  to  these  passengers.  ③ This  application  form  consists  of  two  forms  without  carbon  copy.  The  first  form  is  airline  form  to  be  kept  by  the  department  handling  the  passenger’s application,  the  second  form  is  passenger  form.