{"id":701,"title":"Marine Delay in Start-up Insurance – Claim Form","purpose":"claim","insurer":{"slug":"liberty-general-insurance","name":"Liberty General Insurance Limited"},"source_pdf":"https://www.libertyinsurance.in/Docx/MARINE%20DELAY%20IN%20START-UP%20Claim%20Form.pdf","sha256":"b3ecab10a2677e74676ee7ebb2ec42187bedda4a7d6fd56b24f55e7cc0a4a0b1","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured policyholder to claim insurance for losses related to marine delay in start-up, including loss to cargo during import or inland voyage and loss of gross profit or increased costs due to delay.","notes":["Ignore Section I if loss/damage is for Inland Voyage and ignore Section II if loss/damage is for Import Voyage.","Attach copies of relevant documents such as surveys and correspondence with carriers.","Provide detailed and accurate information to avoid delays in claim processing."],"title":"Marine Delay in Start-up Insurance – Claim Form","submit":{"to":"Liberty General Insurance Limited","how":"","address":"10th Floor, Tower A, Peninsula Business Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai - 400 013"},"purpose":"claim","sections":[{"title":"Section I – Loss to Cargo (Import Voyage)","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":"Describe items and specify if critical or non-critical","type":"text","label":"Description of Items affected (Also state if Critical / Non-Critical)","options":[],"required":null,"pdf_field":""},{"help":"Specify primary and secondary packing if applicable","type":"text","label":"Packaging (If two levels are packing are involved, please 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 voyage","type":"text","label":"Voyage From & To","options":[],"required":null,"pdf_field":""},{"help":"Provide invoice number, value and date","type":"text","label":"Invoice No, Invoice Value & Date","options":[],"required":null,"pdf_field":""},{"help":"Provide relevant transport document numbers and dates","type":"text","label":"B/L, R/R, CNN, AWB etc. 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":"","type":"date","label":"Date of arrival of goods at the destination port / airport / rail or road terminus","options":[],"required":null,"pdf_field":""},{"help":"Provide all relevant dates","type":"date","label":"Date(s) of Discharge and Clearance","options":[],"required":null,"pdf_field":""},{"help":"Describe 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":"","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":"date","label":"Date of Dispatch to Project laydown area","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of arrival of goods at the Project laydown area","options":[],"required":null,"pdf_field":""},{"help":"","type":"yes-no","label":"Has Open delivery been taken?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of application for Survey","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Date of survey held","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of the Surveyor / Loss Assessor","options":[],"required":null,"pdf_field":""},{"help":"Provide date and details","type":"text","label":"Date & Details of examination of contents at the final warehouse","options":[],"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":"If paid, provide payment date","type":"text","label":"Has the value of the goods been paid to the vendors? If yes, please indicate the date on which paid","options":[],"required":null,"pdf_field":""},{"help":"Fill all columns with relevant details","type":"table","label":"Details of loss : Type of Loss, When Noticed, Items affected, Cause of Loss, Estimate of Loss","options":[],"required":null,"pdf_field":""},{"help":"Attach survey copy if yes","type":"yes-no","label":"Whether Ship Survey Held? If Yes, please attach a copy","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Attach correspondence copies if yes","type":"yes-no","label":"Whether claim lodged on carriers for recovery? Please enclose copies of correspondence exchanged with the Carriers","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of other insurances, if any, on affected property","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Section II – Loss to Cargo (Inland Voyage)","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":"Describe items and specify if critical or non-critical","type":"text","label":"Descriptions of Items affected (Also state if Critical / Non-Critical)","options":[],"required":null,"pdf_field":""},{"help":"Specify primary and secondary packing if applicable","type":"text","label":"Packaging (If two levels  of packing are involved, please 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 voyage","type":"text","label":"Voyage From & To","options":[],"required":null,"pdf_field":""},{"help":"Provide invoice number, value and date","type":"text","label":"Invoice No, Invoice Value & 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":"","type":"date","label":"Date of arrival of goods at the Project laydown area (in case of transit by Air, please also state the date of arrival at the airport)","options":[],"required":null,"pdf_field":""},{"help":"Describe 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":"","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":"Provide date and details","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":"Please indicate any risk notes executed at the time of booking","options":[],"required":null,"pdf_field":""},{"help":"If paid, provide payment date","type":"text","label":"Has the value of the goods been paid to the vendors? If yes, please indicate the date on which paid","options":[],"required":null,"pdf_field":""},{"help":"Fill all columns with relevant details","type":"table","label":"Details of loss : Type of Loss, When Noticed, Items affected, Cause of Loss, Estimate of Loss","options":[],"required":null,"pdf_field":""},{"help":"Attach correspondence copies if yes","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":"","type":"text","label":"Details of other insurances, if any, on affected property","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Section III – Loss of Gross Profit or Standing Charges and/or Debt Servicing and/or Increased Cost of Working","fields":[{"help":"","type":"date","label":"Original date(s) of completion of works including full operational testing.","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Actual date(s) of completion of works including full operational testing","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Scheduled Commercial Operation Date","options":[],"required":null,"pdf_field":""},{"help":"","type":"date","label":"Actual Commercial Operation Date","options":[],"required":null,"pdf_field":""},{"help":"Explain reasons for delay","type":"text","label":"Reasons of Delay (In case the loss is on account of Item(s) 1.2 and/or 1.3 and/or 1.4 of Section II of the Policy)","options":[],"required":null,"pdf_field":""},{"help":"Select applicable indemnity types","type":"checkbox","label":"Indemnity Claimed in respect of","options":["Loss of Gross Profit","Fixed Costs and/or Debt Service","Increased Cost of Working"],"required":null,"pdf_field":""},{"help":"Provide turnover amount for 12 months from completion","type":"amount","label":"Turnover achieved during 12 months counted from the midnight of the day of completion of the insured works including full operational testing.","options":[],"required":null,"pdf_field":""},{"help":"Provide gross profit amount for 12 months from completion","type":"amount","label":"Gross Profit achieved during 12 months counted from the midnight of the day of completion of the insured works including full operational testing.","options":[],"required":null,"pdf_field":""},{"help":"List fixed costs with nature of expenses","type":"text","label":"Fixed Costs incurred during the period of delay excluding any sum saved in consequence of the occurrence giving rise to a claim under the Policy (Please indicate separately nature of expenses wise)","options":[],"required":null,"pdf_field":""},{"help":"List debt service costs with nature of expenses","type":"text","label":"Debt Service Costs incurred during the period of delay excluding any sum saved in consequence of the occurrence giving rise to a claim under the policy (Please indicate separately nature of expenses wise)","options":[],"required":null,"pdf_field":""},{"help":"List additional expenses with nature","type":"text","label":"Additional expenditure incurred to avoid reduction in turnover during the period of delay (Please indicate separately nature of expenses wise)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please indicate any variations and special circumstances affecting the Scheduled Commercial Operation Date and / or Business had the delay not occurred","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Please indicate any variations and special circumstances affecting the Business after the Scheduled Commercial Operation Date.","options":[],"required":null,"pdf_field":""},{"help":"Provide details if received","type":"text","label":"Have you received any liquidated damages payments on account of delay? If yes, please provide details.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Details of other Insurance(s) held, if any","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Any other information you would like to share","options":[],"required":false,"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":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"}],"deadlines":[],"applies_to":"Marine Delay in Start-up Policy claims","attachments":["Copy of Ship Survey if held","Copies of correspondence exchanged with the Carriers if claim lodged","Other supporting documents as required"],"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 duplicate claims have been made to other insurers except as disclosed.","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":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/701-marine-delay-in-start-up-insurance-claim-form"}