{"id":695,"title":"Marine Claim Form – Export Policy / Voyage / Cross 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(Export%20and%20Cross%20Voyage).pdf","sha256":"a30744a070924d371425a9f531ab3384a21188ac9dcda2ff945de97adb531e25","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim for loss or damage under a marine cargo export or cross voyage insurance policy.","notes":[],"title":"Marine Claim Form – Export Policy / Voyage / Cross Voyage","submit":{"to":"Liberty General Insurance Limited, Unit 1501 & 1502, 15th Floor, Tower 2, One International Center, Senapati Bapat Marg, Prabhadevi, Mumbai - 400013","how":"post","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":"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":"Include full address and phone number","type":"text","label":"Address of the Insured and Contact No.","options":[],"required":null,"pdf_field":""},{"help":"Describe the goods affected by the loss","type":"text","label":"Description of Items affected","options":[],"required":null,"pdf_field":""},{"help":"Specify packaging details","type":"text","label":"Packaging (If two levels are packing are involved, pl indicate both Primary and Secondary Packing)","options":[],"required":null,"pdf_field":""},{"help":"Provide names of consignor and consignee","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 Bill of Lading or equivalent document number and date","type":"text","label":"B/L, R/R, CNN, AWB etc No & Date","options":[],"required":null,"pdf_field":""},{"help":"Name of the transport carrier","type":"text","label":"Name of the Carrier","options":[],"required":null,"pdf_field":""},{"help":"Date and location when goods were given to carrier","type":"date","label":"Date & Place goods were handed over to carrier","options":[],"required":null,"pdf_field":""},{"help":"Date goods arrived at destination","type":"date","label":"Date of arrival of goods at the destination port / airport","options":[],"required":null,"pdf_field":""},{"help":"Dates when goods were discharged and cleared","type":"date","label":"Date(s) of Discharge and Clearance","options":[],"required":null,"pdf_field":""},{"help":"Describe the condition of goods on delivery","type":"text","label":"External Condition of the goods at the time of taking delivery","options":[],"required":null,"pdf_field":""},{"help":"Date when application was made for Short Landing Certificate","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":"Date goods were dispatched to final warehouse","type":"date","label":"Date of Dispatch to final warehouse","options":[],"required":null,"pdf_field":""},{"help":"Date goods arrived at final warehouse","type":"date","label":"Date of arrival of goods at the final warehouse","options":[],"required":null,"pdf_field":""},{"help":"Indicate if open delivery was taken","type":"yes-no","label":"Has Open delivery been taken?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Date when survey application was made","type":"date","label":"Date of application for Survey","options":[],"required":null,"pdf_field":""},{"help":"Date when survey was conducted","type":"date","label":"Date of Survey held","options":[],"required":null,"pdf_field":""},{"help":"Name of the person who surveyed the loss","type":"text","label":"Name of the Surveyor / Loss Assessor","options":[],"required":null,"pdf_field":""},{"help":"Provide 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":"State if value received and date","type":"text","label":"Has the value of the goods been received? If yes, please indicate the date on which received","options":[],"required":null,"pdf_field":""},{"help":"Provide detailed description of the 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":"Indicate if claim lodged on carrier and attach correspondence","type":"yes-no","label":"Whether claim lodged on carrier for recovery? Please enclose copies of correspondence exchanged with the Carriers","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Provide details of any other insurance on the goods","type":"text","label":"Details of other insurances, if any, on affected property","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declarations and Signature","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":"Signature of the policyholder","type":"signature","label":"Signature of the Insured","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Export Policy / Voyage / Cross Voyage","attachments":["Copy of Ship Survey if held","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 my 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.","False or fraudulent statements or concealment of material information will render the policy null and void and claims forfeited.","Receipt of this claim form or documents does not imply acceptance of the claim; the company may require further information or reject the claim."],"dropped_labels":2},"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/695-marine-claim-form-export-policy-voyage-cross-voyage"}