{"id":685,"title":"CLAIM FORM FOR BAGGAGE INSURANCE POLICY","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/BAGGAGE%20INSURANCE%20POLICY%20-%20Claim%20Form.pdf","sha256":"eac179d55b615b6c1d9cebf410d7aebad86b1aa2d703df2123d1de97c8894c48","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim for loss or damage to baggage under the baggage insurance policy.","notes":["The issue of this form is not to be taken as an admission of liability.","If loss is due to theft or pilferage, it must be reported to police and a copy of the report attached.","If loss/damage occurred in custody of a common carrier, notify the carrier immediately and provide copies of notifications and claims made.","Provide original supporting documents and policy copies where applicable."],"title":"CLAIM FORM FOR BAGGAGE INSURANCE POLICY","submit":{"to":"Liberty General Insurance Limited, Unit 1501 & 1502, 15th Floor, Tower 2, One International Center, Senapati Bapat Marg, Prabhadevi, Mumbai - 400013","how":"post or as per company instructions","address":"Liberty General Insurance Limited, Unit 1501 & 1502, 15th Floor, Tower 2, One International Center, Senapati Bapat Marg, Prabhadevi, Mumbai - 400013"},"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":"","type":"phone","label":"Contact Number","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Loss","fields":[{"help":"Provide the exact date and time when the loss occurred","type":"date","label":"Date and Time of loss","options":[],"required":null,"pdf_field":""},{"help":"Specify the location where the loss happened","type":"text","label":"Place of loss","options":[],"required":null,"pdf_field":""},{"help":"Describe how the loss or damage occurred","type":"text","label":"Nature and cause of loss","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"If suspected due to theft or pilferage, was it reported to the Police","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide police station address if reported","type":"text","label":"If ‘Yes’ please give the address of the Police Station","options":[],"required":null,"pdf_field":""},{"help":"Explain why the loss was not reported to police","type":"text","label":"If ‘No’ please give reason why","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Claim Details","fields":[{"help":"Enter the total amount claimed in Indian Rupees","type":"amount","label":"Amount of loss sustained ( In Rs)","options":[],"required":null,"pdf_field":""},{"help":"List each item with date of purchase, description, and sum claimed","type":"table","label":"Particulars of Baggage\nDate of purchase\nFull description of Item\nSum claimed","options":[],"required":null,"pdf_field":""},{"help":"Start date of travel","type":"date","label":"Traveling from","options":[],"required":null,"pdf_field":""},{"help":"End date of travel","type":"date","label":"to","options":[],"required":null,"pdf_field":""},{"help":"Specify the mode of travel (e.g. air, train, bus)","type":"text","label":"Mode of Travel, please specify","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Did the loss / damage occur whilst in custody of common carrier?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of the carrier if loss occurred in their custody","type":"text","label":"If yes please provide the carrier name","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Was the Open Delivery of Baggage (for damages) taken from Carrier?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach copy of notification to carrier if yes","type":"yes-no","label":"Was the Carrier immediately notified on notice of loss / damage? If “Yes”, please provide a copy. If not, this must be done immediately.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach copy of claim against carrier if yes","type":"yes-no","label":"Has a formal claim been made against the carrier? If “Yes”, please provide a copy. If not, please do so without delay.","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter amount of compensation received from carrier","type":"amount","label":"Details of Compensation received from Carrier, if any","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of other insurance policy if yes","type":"yes-no","label":"Is the Loss/damage covered under any other Insurance? If \"Yes\", specify details as below, also provide the policy copy","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Name of other insurer if applicable","type":"text","label":"Name of the Insurer","options":[],"required":null,"pdf_field":""},{"help":"Period of other insurance coverage","type":"text","label":"Period of insurance","options":[],"required":null,"pdf_field":""},{"help":"Policy number of other insurance","type":"text","label":"Policy number","options":[],"required":null,"pdf_field":""},{"help":"Sum insured under other insurance","type":"amount","label":"Amount of Insurance (in Rs)","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by Insured","fields":[{"help":"Location where form is signed","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign here","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Baggage Insurance Policy claims","attachments":["Copy of police report if theft or pilferage reported","Copy of notification to carrier if loss/damage occurred in custody of carrier","Copy of formal claim made against carrier if any","Copy of other insurance policy if loss/damage covered under other insurance"],"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 endorsement.","No similar claim has been made with any other insurance company except as disclosed.","False or fraudulent statements or concealment of material information will void the policy and forfeit claims.","Receipt of this claim form or documents does not constitute admission of liability by the company."],"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/685-claim-form-for-baggage-insurance-policy"}