{"id":678,"title":"Claim Form – Consequential Loss of Profit","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/CONSEQUENTIAL%20LOSS%20(FIRE)%20-%20Claim%20Form(FLOP).pdf","sha256":"19ed5c5e3865ac12b6d9e4314ed9985fde3b82e170a0fd4dc631c6cfc2c80e1c","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for insured policyholders to claim consequential loss of profit under their fire insurance policy with Liberty General Insurance Limited.","notes":["The issue of this form is not to be taken as admission of liability.","Notify the company without delay as soon as loss or damage is known.","If any detail or information is not readily available, do not delay dispatch of this form; such particulars may be sent later."],"title":"Claim Form – Consequential Loss of Profit","submit":{"to":"Liberty General Insurance Limited","how":"","address":"Unit 1501 & 1502, 15th Floor, Tower 2, One International Center, Senapati Bapat Marg, Prabhadevi, Mumbai - 400013"},"purpose":"claim","sections":[{"title":"A. INSURED","fields":[{"help":"","type":"text","label":"Name of Insured","options":[],"required":null,"pdf_field":""},{"help":"Include full address, phone numbers, and email ID","type":"text","label":"Complete Address (incl. Telephone nos./email id)","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates of insurance period","type":"date","label":"Period of Insurance : From To","options":[],"required":null,"pdf_field":""},{"help":"Specify sum insured and basis of indemnity","type":"amount","label":"Sum Insured (Basis of Indemnity  - Turnover basis or Output basis)","options":[],"required":null,"pdf_field":""},{"help":"Location where loss occurred","type":"text","label":"Loss Location","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"B. DETAILS OF THE LOSS","fields":[{"help":"Provide date, time and cause of the loss","type":"text","label":"Date, Time & Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"State if loss was reported under base policy and if liability is admissible","type":"text","label":"Whether Loss intimated under base (Fire/Machinery) Policy Is liability admissible under base Policy","options":[],"required":null,"pdf_field":""},{"help":"Describe production or turnover loss","type":"text","label":"Has Production/Turnover been lost (Give details)","options":[],"required":null,"pdf_field":""},{"help":"Estimated date for resumption of normal production","type":"text","label":"By when is the normal production estimated to be resumed?","options":[],"required":null,"pdf_field":""},{"help":"Estimate loss amount during interruption","type":"amount","label":"What is the estimated loss of turnover/production during the period of interruption?","options":[],"required":null,"pdf_field":""},{"help":"If yes, give details","type":"text","label":"Have you incurred any increased cost of working to minimize loss?","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"C. DETAILS OF OTHER INSURANCES","fields":[{"help":"","type":"text","label":"Give details of other Insurance’s, if any, covering the affected equipment.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"D. DETAILS OF PREVIOUS LOSSES","fields":[{"help":"","type":"text","label":"Give details of Previous Claims, if any, on the affected equipment.","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Consequential Loss (Fire) Insurance claims","attachments":[],"declarations":["The insured declares that the above questions have been conscientiously and faithfully answered and is liable for the correctness and completeness of the statement."],"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/liberty-general-insurance/678-claim-form-consequential-loss-of-profit"}