{"id":694,"title":"Marine Cargo - Claim Form – Import Policy / Voyage","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/Marine%20Cargo%20Claim%20Form%20-%20(Inland).pdf","sha256":"3c4ba836c16fde7e2d9a320ef5ab16068a20249881c92018115fdb392bed83c8","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured to claim for loss or damage under a marine cargo inland transit insurance policy.","notes":["Issuance of this form does not imply admission of liability."],"title":"Marine Cargo - Claim Form – Import Policy / Voyage","submit":{"to":"","how":"","address":""},"purpose":"claim","sections":[{"title":"Claim Details","fields":[{"help":"","type":"text","label":"Policy Number","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Insured","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Insured and Contact No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Description of Items affected","options":[],"required":null,"pdf_field":""},{"help":"Indicate both primary and secondary packaging if applicable","type":"text","label":"Packaging (If two levels are packing are involved, pl. indicate both Primary and Secondary Packing)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Names of the Consignor and Consignee","options":[],"required":null,"pdf_field":""},{"help":"Specify origin and destination of the voyage","type":"text","label":"Voyage From & To","options":[],"required":null,"pdf_field":""},{"help":"Provide invoice number and date","type":"text","label":"Invoice No & Date","options":[],"required":null,"pdf_field":""},{"help":"Provide relevant transport document numbers and dates","type":"text","label":"L/R, R/R, AWB, CNN No & Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Carrier","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date & Place goods were handed over to carrier","options":[],"required":null,"pdf_field":""},{"help":"Include airport arrival date if transit by air","type":"date","label":"Date of arrival of goods at the destination warehouse (in case of transit by Air, pl. also state the date of arrival at the airport)","options":[],"required":null,"pdf_field":""},{"help":"Describe the condition of goods when received","type":"text","label":"External Condition of the goods at the time of taking delivery","options":[],"required":null,"pdf_field":""},{"help":"Only if short landing occurred","type":"date","label":"Date of Application to Port Authorities for issuance of Short Landing Certificate in case of short landing","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reasons, if any, for delay in clearance / taking delivery at the final destination","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of application for Survey","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Surveyor / Loss Assessor","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date on which survey was taken","options":[],"required":null,"pdf_field":""},{"help":"Include date and details of contents examination","type":"text","label":"Date & Details of examination of contents at the final warehouse","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has Open delivery been taken?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"In whose favour was the R.R / GCN / L.R endorsed","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Pl indicate any risk notes executed at the time of booking","options":[],"required":null,"pdf_field":""},{"help":"State yes/no and date if paid","type":"text","label":"Has the value of the goods been paid to the vendors? If yes, pl indicate the date on which paid","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed description of loss","type":"text","label":"Details of loss :  a) Type of Loss  b) When Noticed  c) Items affected  d) Cause of Loss","options":[],"required":null,"pdf_field":""},{"help":"Attach correspondence copies if claim lodged","type":"yes-no","label":"Whether claim lodged on carrier for recovery? Pl enclose copies of correspondence exchanged with the Carriers","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Other Insurance Details","fields":[{"help":"","type":"text","label":"Details of other insurances, if any, on affected property","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration","fields":[{"help":"","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Import Policy / Voyage - Inland Transit","attachments":["Copies of correspondence exchanged with the Carriers (if claim lodged on carrier)"],"declarations":["The information given in this claim form is true to the best of the claimant's knowledge and belief.","All persons having an interest in the property are disclosed and no similar claim has been made with any other insurer except as stated.","No material information relevant to the claim has been withheld or undisclosed.","If any false or fraudulent information is given, the policy shall be void and claims forfeited.","Receipt of this claim form or documents does not imply acceptance of the claim; the insurer may require further information or reject the claim."],"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/694-marine-cargo-claim-form-import-policy-voyage"}