{"id":1985,"title":"PROPOSAL FORM CARRIERS LEGAL LIABILITY INSURANCE","purpose":"proposal","insurer":{"slug":"icici-lombard-general-insurance","name":"ICICI LOMBARD General Insurance Company Limited"},"source_pdf":"https://www.icicilombard.com/docs/default-source/default-document-library/10-carriers-legal-liability-insurance-commercial8c0007ff45fd68ff8a0df0055fa61230.pdf","sha256":"36587a3b9f4b1f2cc10fc1af3a8fde76adb91a298d97d9f25a2b5d955d5af530","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by companies or businesses seeking carriers legal liability insurance to provide detailed information about their business, financials, claims history, and insurance requirements. It is filled by the applicant or their authorised insurance representative.","notes":["Form may be completed by authorised insurance representative","Use separate sheet if insufficient space","Politically Exposed Persons (PEPs) definition provided","Attach copy of House airway bill if used","Statutory warning on prohibition of rebates under Section 41 of Insurance Act 1938"],"title":"PROPOSAL FORM CARRIERS LEGAL LIABILITY INSURANCE","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details of Applicant","fields":[{"help":"","type":"text","label":"Company Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Names and qualifications/years experience of directors and senior managers","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Employees","options":[],"required":null,"pdf_field":""},{"help":"Tick the services you provide","type":"checkbox","label":"Services to be insured  Please ü the services you provide to your customers","options":["MTO","Ocean freight forwarder","Air freight forwarder/ air cargo agent","Customs Agent","Road haulier","In-transit warehousing","Packing/ consolidating","Other (please detail)"],"required":null,"pdf_field":""},{"help":"List subsidiary companies if any","type":"text","label":"Subsidiary companies to be named in the insurance","options":[],"required":null,"pdf_field":""},{"help":"Provide company address","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"List trade associations","type":"text","label":"Trade Associations","options":[],"required":null,"pdf_field":""},{"help":"Enter date in DD/MM/YYYY format","type":"date","label":"Date company established: D D / M M / Y Y Y Y","options":[],"required":null,"pdf_field":""},{"help":"Provide details if applicable","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP)","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant or authorised insurance representative"},{"title":"Financial Details","fields":[{"help":"Enter percentage","type":"number","label":"Please estimate what percentage of your annual turnover is paid to independent Road Hauliers, Warehousekeepers, Consolidators, Packers","options":[],"required":null,"pdf_field":""},{"help":"Provide percentage and approximate tonnage or TEUs for each cargo type","type":"table","label":"What percentage of your annual turnover results from carriage of cargo which is: Breakbulk, Containerised, Palletised","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage for each region","type":"table","label":"Please estimate the percentage of your annual traffic to or within each of the following areas: Europe, North America, Middle East, Africa, Australasia, Far East, Central & South America","options":[],"required":null,"pdf_field":""},{"help":"Enter percentage for each cargo type","type":"table","label":"What percentage of your annual turnover is represented by: Refrigerated cargoes, Tobacco Products, Tank containers, Project cargoes, Spirits, Dangerous cargoes, High value goods, General Cargo (eg computers, jewellery, cameras, TVs, audio equipment, mobile phones)","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you have a Customs bond?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter percentage","type":"number","label":"What percentage of your turnover relates to cargo carried under your own house bill of lading and / or house airway bill?","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Number of employees (including directors) involved in any of the above services","options":[],"required":null,"pdf_field":""},{"help":"Provide details for each property","type":"table","label":"Property you own or lease or operate: Location, Services provided, Age, Describe security","options":[],"required":null,"pdf_field":""},{"help":"Provide details for each vehicle","type":"table","label":"Vehicles: Description, Cargo carried, Delivery radius","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please describe the Cargo handling equipment used","options":[],"required":null,"pdf_field":""},{"help":"Tick applicable documents and attach copy of House airway bill if used","type":"checkbox","label":"Please ü the conditions of business and documents you currently use: Documents in your own name: MTD, FIATA AWB, House airway bill - please attach a copy, Forwarder's certificate of receipt, Other (please specify)","options":["MTD","FIATA AWB","House airway bill - please attach a copy","Forwarder's certificate of receipt","Other (please specify)"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Do you hire to others?","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"applicant"},{"title":"Claims Information","fields":[{"help":"","type":"yes-no","label":"General third party liability claims been made against you?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Professional indemnity (errors and omissions) claims been made against you?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Circumstance arisen that could have resulted in any of the above liability claims being made against you?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide claim details if applicable","type":"text","label":"If YES to any of the above, please provide details","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Details of Insurance Cover","fields":[{"help":"Tick the cover options you require","type":"checkbox","label":"Please ü the insurance cover you require","options":["Liability cover if you do not issue your own bill of lading","Liability cover including issuing your own bill of lading","Third party liability","Liability for fines and penalties","Forwarders’ errors and omissions: Basic cover for liability for incorrect or wrongful delivery of Cargo or delay in the handling of your Customer’s Cargo only","Forwarders’ errors and omissions: Liability for customers’ financial loss"],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Are you currently insured for liability risks?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide insurer name, limit, deductible and premium","type":"text","label":"If so, by whom and what is your current limit, deductible and premium?","options":[],"required":false,"pdf_field":""},{"help":"Specify if applicable","type":"text","label":"Do you require a specific limit of liability and/or deductible to be quoted?","options":[],"required":false,"pdf_field":""}],"filled_by":"applicant"},{"title":"Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter designation of signatory","type":"text","label":"Designation","options":[],"required":true,"pdf_field":""},{"help":"Sign and stamp here","type":"signature","label":"Authorized Signatory Signature & Stamp","options":[],"required":true,"pdf_field":""}],"filled_by":"applicant or authorised signatory"}],"deadlines":[],"applies_to":"Carriers legal liability insurance for freight forwarders, hauliers, warehouse operators, customs agents, and related services","attachments":["Separate sheet if insufficient space to answer any questions","Copy of House airway bill if used"],"declarations":["Consent to verify identity/address proof through Central KYC Registry or UIDAI or other modes for KYC","Premium has been paid from legally acquired sources and future premiums will be paid similarly","Information provided is true and no material facts have been misstated or suppressed","Completion of this form does not bind insurer but forms part of contract if accepted","Company has right to call for documents to establish source of funds","Undertake to inform insurer of any changes within 30 days","Aware that false or misleading information may lead to liability"],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"address","value":"ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025","label":"Registered Office Address","level":null,"hours":"normal business hours","applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"t of policy with the term more than one year and the risk coverage for such policy years has not commenced.\n9 | P a g e ICICI Lombard General Insurance Company Limited EMI SURAKSHA IRDA Reg. No. 115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under th","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"address","value":"601 / 602, 6th Floor, Interface Building No. 16, New Link Road, Malad (West), Mumbai - 400 064.","label":"Office Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/sales-literature-prospectus-tripsecure-2.pdf","quote":"064. | ICICI Lombard General Insurance\nIRDA Reg. No. 115 | Company Limited\nMailing Address: | UIN: ICITIOP27058V022627\n601 / 602, 6th Floor, Interface Building No. 16, New | CIN: L67200MH2000PLC129408\nLink Road, Malad (West), Registered Office Address:\nICICI Lombard House, 414, P Balu | SALES LITERATURE / PROSPECTUS TRIPSECURE+\nMarg","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"email","value":"customersupport@icicilombard.com","label":"E-mail","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/sales-literature-prospectus-tripsecure-2.pdf","quote":"e, Prabhadevi, | Alternate No.: 86552 22666 (Chargeable)\nMumbai - 400 025. | Website | : www.iciclombard.com\nE-mail | : customersupport@icicilombard.com\nSections | Clause No | Cover Type | Cover Name | Payment Basis | Sum Insured | Deductible/ Special conditions\nTravel De","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800 2666","label":"Toll free number","level":null,"hours":"normal business hours","applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under this Policy shall be in writing and delivered by hand, pos","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Ground floor- Interface 11, Sixth floor- Interface 16 Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064","label":"Office Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/vibe-prospectus-(1).pdf","quote":"ombard.com Toll free number: 1800 2666 Email: customersupport@icicilombard.com ICICI Lombard General Insurance Co. Ltd. Ground floor- Interface 11, Sixth floor- Interface 16 Office no 601 & 602, New linking Road, Malad (West), Mumbai – 400064\nThere is an Interactive Voice Response (IVR) facility for senior citizens’ grievance redressal for easy and faster reso","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"customersupport@icicilombard.com","label":"Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"grievance the insured person may contact the Company through Website: www.icicilombard.com Toll free: 1800 2666 Email: customersupport@icicilombard.com ICICI Lombard General Insurance Co. Ltd. Ground floorInterface 11, Sixth floor- Interface 16 , Office no 601 & 602, New","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 2666","label":"Toll free","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"115 CIN: L67200MH2000PLC12940 UIN: IRDAN115RPMS0020V01202627\nMailing Address: Registered Office Address: Toll free no : 1800 2666\n13. Notices\nAny notice, direction or instruction given under this Policy shall be in writing and delivered by hand, pos","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800 4254 732","label":"IRDA Grievance Call Centre (IGCC)","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":": Toll free no : 1800 2666 https://bimabharosa.irdai.gov.in/ or IRDA Grievance Call Centre(IGCC) at their toll free no. 1800 4254 732 / 155255\nMailing Address ICICI Lombard General Insurance Company Limited, ICICI Lombard House 414, Veer Savarkar Marg,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf","label":"Branch details for grievance cell","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"ach the grievance cell at any of the company's branches with the details of grievance. For branch details, please visit https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf.\n17. lf lnsured person is not satisfied with the redressal of grievance ,insured person may contact the grievance redre","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/grievanceredressal.com","label":"Grievance redressal officer contact details","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/prospectus-emi-suraksha.pdf","quote":"ach the grievance cell at any of the company's branches with the details of grievance. For branch details, please visit https://www.icicilombard.com/docs/defaultsource/policywordings-product-brochure/final-gro-mapping.pdf.\n17. lf lnsured person is not satisfied with the redressal of grievan","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"url","value":"https://www.icicilombard.com/docs/defaultsource/policy-wordings-product-brochure/final-gromapping.pdf","label":"Branch details for grievance cell","level":null,"hours":null,"applies_to":"all","source_url":"https://www.icicilombard.com/docs/default-source/default-document-library/vibe-prospectus-(1).pdf","quote":"cell at any of the company'sOur branches with the\ndetails | of | grievance. | For | branch | details, | please | visit\nhttps://www.icicilombard.com/docs/defaultsource/policy-wordings-product-brochure/final-gromapping.pdf.\nlf you are not satisfied with the redressal of grievance, You may contact the grievance officer at the details provide","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/icici-lombard-general-insurance/1985-proposal-form-carriers-legal-liability-insurance"}