{"id":1998,"title":"PROPOSAL FORM FOR MARINE EXPORT IMPORT INSURANCE POLICY","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/20241007014-marine-export-import-insurance-forms-8c0007ff45fd68ff8a0df0055fa621cf.pdf","sha256":"4882ab0d912cf3c58d91427fbb81b3c900d2b62cf9194cc0fe7a7da390e69bc4","pages":4,"collected":"2026-10-20","instructions":{"about":"This form is used by individuals or entities (proposers) seeking to apply for marine export/import insurance coverage for goods in transit.","notes":["Answer all questions fully and correctly; mention 'not applicable' where relevant","Insurance contract is based on utmost good faith; disclose all material facts","Policy liability starts only after acceptance of proposal and payment of premium","Use additional sheets if space is insufficient","If vessel is not classified with recognized classification societies, additional premium may apply","Policy documents can be availed in physical form if requested","Use block letters and leave spaces as indicated","Original bills and documents may be required for claims"],"title":"PROPOSAL FORM FOR MARINE EXPORT IMPORT INSURANCE POLICY","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Client Information","fields":[{"help":"Enter full name with spaces between parts","type":"text","label":"Proposer's name (please leave a space after each part of name)","options":[],"required":null,"pdf_field":""},{"help":"Enter full mailing address with spaces between parts","type":"text","label":"Proposer's mailing address (please leave a space after each part of address)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City / Town / Village","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State","options":[],"required":null,"pdf_field":""},{"help":"Enter postal PIN code","type":"number","label":"Pin Code","options":[],"required":null,"pdf_field":""},{"help":"Enter contact phone number","type":"phone","label":"Phone No.","options":[],"required":null,"pdf_field":""},{"help":"Optional fax number","type":"text","label":"Fax Number","options":[],"required":false,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"E-Mail Address","options":[],"required":null,"pdf_field":""},{"help":"Describe the trade or business","type":"text","label":"Proposer's trade or business","options":[],"required":null,"pdf_field":""},{"help":"Enter paid-up capital in million rupees","type":"number","label":"Paid-up capital of the firm (in ` million)","options":[],"required":null,"pdf_field":""},{"help":"Name of the person/entity in whose favour insurance is sought","type":"text","label":"Insurance sought in favour of","options":[],"required":null,"pdf_field":""},{"help":"Select one type","type":"choice","label":"Type of Proposer","options":["Individual","Partnership firm","MSME/SME","Company","Govt.","Others"],"required":null,"pdf_field":""},{"help":"Enter number of units","type":"number","label":"Number of Units","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Risk Details","fields":[{"help":"Select applicable coverage clause","type":"choice","label":"Please indicate coverage required","options":["Institute Cargo Clause (ICC (C))","Institute Cargo Clause (ICC (B))","Institute Cargo Clause (ICC (A))","ICC (Air)","Other Clauses"],"required":null,"pdf_field":""},{"help":"Enter Bill of Lading or Airway Bill number","type":"text","label":"Bill of Lading/Airway Bill (AWB)","options":[],"required":null,"pdf_field":""},{"help":"Enter insured value","type":"amount","label":"Please indicate Value to be insured","options":[],"required":null,"pdf_field":""},{"help":"Describe the goods","type":"text","label":"Description of goods to be insured","options":[],"required":null,"pdf_field":""},{"help":"Describe packing and marks","type":"text","label":"Nature of Packing, marks and numbers","options":[],"required":null,"pdf_field":""},{"help":"Describe voyage/transit details","type":"text","label":"Description of voyage or transit and transshipment, if any","options":[],"required":null,"pdf_field":""},{"help":"Additional details of goods","type":"text","label":"Details of Goods","options":[],"required":null,"pdf_field":""},{"help":"Details of voyage or transit","type":"text","label":"Voyage / Transit","options":[],"required":null,"pdf_field":""},{"help":"Details of single transit dispatch","type":"text","label":"Single Transit dispatch details","options":[],"required":null,"pdf_field":""},{"help":"Enter journey details","type":"text","label":"Please indicate journey details","options":[],"required":null,"pdf_field":""},{"help":"Select mode of conveyance","type":"choice","label":"Please indicate","options":["Sea","Air","Post"],"required":null,"pdf_field":""},{"help":"Select mode of conveyance","type":"choice","label":"Please indicate mode of conveyance","options":["Sea","Air","Post"],"required":null,"pdf_field":""},{"help":"Enter basis of valuation","type":"text","label":"Please indicate basis of valuation (e.g. Invoice Value/G1F)","options":[],"required":null,"pdf_field":""},{"help":"Specify type of cover required","type":"text","label":"Type of Insurance Cover Required","options":[],"required":null,"pdf_field":""},{"help":"Enter vessel name","type":"text","label":"Name of vessel","options":[],"required":null,"pdf_field":""},{"help":"Enter Bill of Lading or AWB number","type":"text","label":"Bill of Lading Number / Air Way Bill Number","options":[],"required":null,"pdf_field":""},{"help":"Provide bankers details if applicable","type":"text","label":"Bankers Details (Only if they have interest in the goods)","options":[],"required":false,"pdf_field":""},{"help":"Enter unit of measurement","type":"text","label":"Unit of Measurement","options":[],"required":null,"pdf_field":""},{"help":"Enter rate per unit","type":"amount","label":"Rate Per Unit","options":[],"required":null,"pdf_field":""},{"help":"Enter total amount","type":"amount","label":"Total Amount","options":[],"required":null,"pdf_field":""},{"help":"Enter value of insurance","type":"amount","label":"Value of Insurance","options":[],"required":null,"pdf_field":""},{"help":"Select yes or no","type":"choice","label":"Do you wish to avail policy documents in physical form","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter nominee's name","type":"text","label":"Nominee Name","options":[],"required":false,"pdf_field":""},{"help":"Enter relationship with insured","type":"text","label":"Relationship with the Insured","options":[],"required":false,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No.","options":[],"required":false,"pdf_field":""},{"help":"Enter email ID","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter address","type":"text","label":"Present & Permanent Address","options":[],"required":false,"pdf_field":""},{"help":"Enter authorized person's name if nominee is minor","type":"text","label":"Authorized person for Minor Nominee","options":[],"required":false,"pdf_field":""},{"help":"Enter bank details for refund of premium","type":"text","label":"Bank Details","options":[],"required":false,"pdf_field":""},{"help":"Enter account holder name","type":"text","label":"Account Holder Name","options":[],"required":false,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Enter bank account number","type":"text","label":"Account No.","options":[],"required":false,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Risk and Insurance History Details","fields":[{"help":"Politically Exposed Persons status","type":"yes-no","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answer is yes","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP)","options":[],"required":false,"pdf_field":""},{"help":"Indicate previous or current marine export/import insurance","type":"yes-no","label":"Are you at present or have you been insured for Marine Export/ Import transit?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of insurer if previously insured","type":"text","label":"Name of insurance company","options":[],"required":false,"pdf_field":""},{"help":"Indicate if any claims made","type":"yes-no","label":"Have you made any claim under Marine Export/ Import Insurance?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide claim details in table format","type":"table","label":"If so, give details in the following format (attach separate sheet if required): Year of claim, Premium, Incurred claim (`), Number of claims (Nos.)","options":[],"required":false,"pdf_field":""},{"help":"Name of classification society if applicable","type":"text","label":"Classification Society","options":[],"required":false,"pdf_field":""},{"help":"Country where vessel is registered","type":"text","label":"Country of Registration","options":[],"required":false,"pdf_field":""},{"help":"Enter vessel age in years","type":"number","label":"Age of the Vessel","options":[],"required":false,"pdf_field":""},{"help":"Enter vessel size in GRT","type":"number","label":"Size of the Vessel (Gross Registered Tonnage)","options":[],"required":false,"pdf_field":""},{"help":"Select vessel nature","type":"choice","label":"Nature of Vessel","options":["Liners","Tramps"],"required":false,"pdf_field":""},{"help":"Indicate if ship is classified","type":"yes-no","label":"Whether Ship is classified or not*","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Start date of insurance period","type":"date","label":"Period of insurance: From","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Extensions","fields":[{"help":"Select yes to avail extension","type":"yes-no","label":"If you want to avail of extension of policy by payment of additional premium, please specify War or warlike operations, Strike, Riot and Civil Commotion","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select yes to avail duty insurance cover","type":"yes-no","label":"If you want to avail of extension of policy by payment of additional premium, please specify Duty Insurance Cover (in case you wish to avail of Duty Insurance, please fill attached form for such coverage)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide any other relevant information","type":"text","label":"Any additional information relevant to the policy applied for","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration and Signature","fields":[{"help":"Sign the form","type":"signature","label":"Proposer’s Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Print name of proposer","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"Enter designation if applicable","type":"text","label":"Designation","options":[],"required":false,"pdf_field":""},{"help":"Print proposer name again","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"If signed by other than proposer, specify relationship","type":"text","label":"Relationship with Proposer","options":[],"required":false,"pdf_field":""},{"help":"Enter witness address","type":"text","label":"Address of Witness","options":[],"required":true,"pdf_field":""},{"help":"Enter witness name","type":"text","label":"Name of the Witness","options":[],"required":true,"pdf_field":""},{"help":"Proposer signature","type":"signature","label":"Signature of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Witness signature","type":"signature","label":"Signature of Witness","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":["Inform the company of any changes in details immediately, not later than 30 days"],"applies_to":"Marine Export Import Insurance Policy","attachments":["Attached form for Duty Insurance Cover (if availing Duty Insurance)","Separate sheet for details if space is insufficient","Separate sheet for claim details if required"],"declarations":["The statements and particulars given are true, accurate and complete and form the basis of the contract","Consent to verify identity/address proof through Central KYC Registry or UIDAI or other modes","Premiums paid are from legally acquired sources and future premiums will be similarly paid","Company may call for documents to establish source of funds","Proposer undertakes to inform of any changes within 30 days","False or misleading information may lead to liability","Declaration by person filling form for proposer who is illiterate or signs in vernacular confirming explanation and understanding","Prohibition of rebates under Section 41 of Insurance Act 1938"],"dropped_labels":6},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"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/1998-proposal-form-for-marine-export-import-insurance-policy"}