{"id":484,"title":"CLAIM FORM FOR MARINE INLAND TRANSIT INSURANCE (Notification of Loss/ Damage)","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/20220804005-marine-transit-insurance-claim.pdf","sha256":"4e457ffdb23bb09bbbee252a895685cd02e45af9ac78ccb596af0081525e3860","pages":3,"collected":"2026-10-20","instructions":{"about":"This form is for policyholders to notify and claim for loss or damage under Marine Inland Transit Insurance.","notes":["Use copies of correspondence and certificates as attachments","In case of third-party property damage/bodily injury, file an FIR if applicable","Claims Manager will appoint a licensed surveyor within 24 hours of claim reporting","Submit all necessary documents as listed to the assigned Claims Manager or Surveyor","Assessment and approval of repair/replacement details will be done by Claims Manager/Surveyor","Salvage value is the assessed amount the damaged asset will fetch in the open market","Contact toll-free number 1800 2666 or email customersupport@icicilombard.com for assistance"],"title":"CLAIM FORM FOR MARINE INLAND TRANSIT INSURANCE (Notification of Loss/ Damage)","submit":{"to":"assigned Claims Manager (CSM) / Surveyor","how":"submit documents to the assigned CSM/Surveyor","address":""},"purpose":"claim","sections":[{"title":"Details of Insured","fields":[{"help":"","type":"text","label":"Name","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address for Correspondence","options":[],"required":null,"pdf_field":""},{"help":"Enter a valid phone number","type":"phone","label":"Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Enter your insurance policy number","type":"text","label":"Policy No.","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Transport Details","fields":[{"help":"Select the mode of transport","type":"choice","label":"Mode of conveyance Rail/Road","options":["Rail","Road"],"required":null,"pdf_field":""},{"help":"Provide full name and address of the carrier","type":"text","label":"Name & address of the transport carrier","options":[],"required":null,"pdf_field":""},{"help":"Enter the Lorry Receipt, Railway Receipt or Air Way Bill number and date","type":"text","label":"LR/ RR/ AWB Number and Date","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Delivery and Loss Details","fields":[{"help":"Enter the date goods arrived at destination","type":"date","label":"Date of arrival of goods at destination","options":[],"required":null,"pdf_field":""},{"help":"Enter the date you requested delivery from carrier","type":"date","label":"Date when delivery from carriers applied for","options":[],"required":null,"pdf_field":""},{"help":"Enter the date you took delivery of goods","type":"date","label":"Date when delivery of goods taken","options":[],"required":null,"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":null,"pdf_field":""},{"help":"Provide date and location where loss or damage was first noticed","type":"text","label":"Date and place when loss/damage was noticed","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Carrier Remarks and Claims","fields":[{"help":"Indicate if you obtained remarks from the carrier","type":"yes-no","label":"Whether remarks of carrier obtained","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Indicate if open delivery was obtained","type":"yes-no","label":"Whether open delivery obtained from carrier","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the date you lodged claim with the carrier; enclose correspondence copies","type":"date","label":"Date when the claim lodged on the carrier","options":[],"required":null,"pdf_field":""},{"help":"Indicate if you obtained Non Delivery/Damage Certificate; enclose copy","type":"yes-no","label":"Whether Non Delivery/Damage Certificate obtained from carrier","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Loss Description and Values","fields":[{"help":"Describe the loss and its cause","type":"text","label":"Description and cause of loss","options":[],"required":null,"pdf_field":""},{"help":"Provide estimated monetary loss","type":"amount","label":"Estimate of loss","options":[],"required":null,"pdf_field":""},{"help":"Provide salvage value if applicable","type":"amount","label":"Probable salvage value, if any","options":[],"required":false,"pdf_field":""},{"help":"Enter the CIF or invoice value of the goods","type":"amount","label":"CIF / Invoice value of goods","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Additional Information","fields":[{"help":"Provide any other relevant details","type":"text","label":"Any other information relevant to processing of claim","options":[],"required":false,"pdf_field":""},{"help":"Provide details if other insurance covers the same risk","type":"text","label":"Details of Other insurance covering same risk","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Politically Exposed Person (PEP) Declaration","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/Close relatives/Associates of PEP?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"If yes, please give details (Nature of relationship and position held by PEP)","options":[],"required":false,"pdf_field":""}],"filled_by":"policyholder"},{"title":"Declaration and Signature","fields":[{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"policyholder"}],"deadlines":["Assessment sheet / Survey report will be furnished within 15 days of receipt of claim form and documents","Claim will be decided within 7 days of receipt of the assessment sheet / survey report"],"applies_to":"Marine Inland Transit Insurance claims","attachments":["copies of correspondence with the Acknowledgement due Card","copy of Non Delivery/Damage Certificate","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 proposal or policy endorsement","No material information relevant to the claim has been withheld or not disclosed","False or fraudulent statements or concealment of material information will void the policy and claims","Receipt of 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"],"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/484-claim-form-for-marine-inland-transit-insurance-notification-of-loss-damage"}