{"id":389,"title":"CLAIM FORM FOR MARINE EXPORT/ IMPORT INSURANCE POLICY","purpose":"claim","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/20220804012-export-import-insurance-forms-rev-28c0007ff45fd68ff8a0df0055f9a8160.pdf","sha256":"ab7e4bb02bb7746c6459aa88446a8ae2115f88de0b33ec4a92e5db3b717123c4","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is used by the insured policyholder to notify and claim loss or damage under a marine export/import insurance policy.","notes":["The issue of this form is not to be taken as an admission of liability.","Attach copies of correspondence with the shipping company/carrier with acknowledgement due card.","In case of third-party property damage/bodily injury or fire, file an FIR if applicable as per policy terms.","A licensed surveyor will be appointed within 24 hours of claim reporting.","Assessment sheet/survey report will be furnished within 15 days of receipt of claim form and documents.","Claim decision will be made within 7 days of receipt of assessment sheet/survey report.","Use original documents and provide all necessary supporting documents as listed.","Provide KYC and NEFT details as per AML guidelines."],"title":"CLAIM FORM FOR MARINE EXPORT/ IMPORT INSURANCE POLICY","submit":{"to":"Connect via Toll-free No.: 1800 2666, Email ID: customersupport@icicilombard.com, or website https://coclaims.icicilombard.com/claimstracker/CommercialClaims/ccplandingpage.aspx","how":"Call, email or upload documents on website","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address for Correspondence","options":[],"required":true,"pdf_field":""},{"help":"Provide a valid phone number","type":"phone","label":"Contact No.","options":[],"required":true,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Transport and Shipment Details","fields":[{"help":"Select the mode of transport used","type":"choice","label":"Mode of conveyance Rail/Road/Air/Sea","options":["Rail","Road","Air","Sea"],"required":true,"pdf_field":""},{"help":"Provide full name and address of the carrier","type":"text","label":"Name & address of the transport carrier","options":[],"required":true,"pdf_field":""},{"help":"Enter Bill of Lading, Lorry Receipt, Railway Receipt or Air Way Bill number and date","type":"text","label":"BL /LR/ RR/ AWB Number and Date","options":[],"required":true,"pdf_field":""},{"help":"Date when goods arrived at destination","type":"date","label":"Date of arrival of goods at destination","options":[],"required":true,"pdf_field":""},{"help":"Date you requested delivery from carrier","type":"date","label":"Date when delivery from carriers applied for","options":[],"required":true,"pdf_field":""},{"help":"Date goods were taken from port or airport","type":"date","label":"Date when delivery of goods taken from Port/ Airport","options":[],"required":true,"pdf_field":""},{"help":"Explain any delay in taking delivery","type":"text","label":"Reasons for delay in taking delivery, if any","options":[],"required":false,"pdf_field":""},{"help":"Describe the condition of goods when received","type":"text","label":"External conditions of the goods on arrival:","options":[],"required":true,"pdf_field":""},{"help":"Specify date and location where loss or damage was first observed","type":"text","label":"Date and place when loss/damage was noticed","options":[],"required":true,"pdf_field":""},{"help":"Indicate if a survey request was made","type":"yes-no","label":"Was a request lodged with the shipping company/ carrier to carry out a survey?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Date when survey was conducted","type":"date","label":"If so, please mention date of survey?","options":[],"required":false,"pdf_field":""},{"help":"Provide date and place of contact with claim agent","type":"text","label":"Please mention the date and place of contacting claim settling agent.","options":[],"required":false,"pdf_field":""},{"help":"Indicate if remarks were obtained","type":"yes-no","label":"Whether remarks of shipping company/ carrier obtained","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Indicate if open delivery was obtained","type":"yes-no","label":"Whether open delivery obtained from shipping company/ carrier","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Date claim was lodged with carrier; attach correspondence copies","type":"date","label":"Date when claim lodged on the shipping company/ carrier.","options":[],"required":false,"pdf_field":""},{"help":"Describe what was lost or damaged and how","type":"text","label":"Description and cause of loss","options":[],"required":true,"pdf_field":""},{"help":"Provide estimated monetary loss","type":"amount","label":"Estimate of loss.","options":[],"required":true,"pdf_field":""},{"help":"Estimated salvage value of damaged goods","type":"amount","label":"Probable salvage value, if any","options":[],"required":false,"pdf_field":""},{"help":"Cost, Insurance and Freight value of goods","type":"amount","label":"CIF value of goods","options":[],"required":true,"pdf_field":""},{"help":"Details of delivery issues and attach supporting documents","type":"text","label":"Non delivery/ partial delivery/ shortage/ loss issued by the carrier. If any, attach the documents.","options":[],"required":false,"pdf_field":""},{"help":"Provide any additional relevant details and attach lists","type":"text","label":"Any other relevant information (Please attach separate list showing the list of goods lost, destroyed or stolen/ their invoice value or value declared for insurance/ and estimated repair cost of damage items)","options":[],"required":false,"pdf_field":""},{"help":"Provide details if other insurance covers this risk","type":"text","label":"Details of Other insurance covering same risk","options":[],"required":false,"pdf_field":""},{"help":"Select yes or no regarding Politically Exposed Person status","type":"choice","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/Close relatives/Associates of PEP*? Yes No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Describe relationship and position 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":"insured"},{"title":"Declarations and Signature","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Date of signing the form","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Marine export/import insurance policies","attachments":["Claim bill / Claim Form duly filled up","Photographs / Video of damaged property/item under claim","Invoice copy & packing list","Lorry Receipt/ Bill of Lading/ Bill of Entry/ Air way bill/ Goods receipt Note – as applicable","Monetary Claim or transporter","Damage Certificate","Document/s in support of admissibility of the claim, for instance, Service Engineer’s Report, Fire Brigade Report, etc.","Repair/ replacement quotation, invoice and payment proofs for each and every item as claimed (if items to be repaired or reinstated)","Documents substantiating the quantum & value of the items under claim (if items not to be repaired or reinstated)","Offer for retention of salvage, if any","KYC / NEFT Details as per AML guidelines","Any other document which may be specified by the surveyor post completion of initial survey"],"declarations":["The information given in this claim form is true, correct and complete.","All persons having interest in the property are disclosed as per the proposal or policy endorsements.","No material information relevant to the claim has been withheld or undisclosed.","False or fraudulent statements or concealment of material information will void the policy and claims.","Receipt of this claim form or documents does not constitute admission of liability by the company.","Consent is given to verify identity/address proof through Central KYC Registry, UIDAI or other modes for KYC purposes."],"dropped_labels":0},"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/389-claim-form-for-marine-export-import-insurance-policy"}