Claim Form - Marine Inland Policy-ICICI
Claim Form - Marine Inland Policy-ICICI
Claim Form - Marine Inland Policy-ICICI
Issued At
Intermediary Details
Agency/Broker Code
Agency/Broker Name
Agent's/Brokers Email ID
: From :
To
: From :
To
Mode of Conveyance
: Rs.
: Rs.
: Rs.
Description of Packaging
Basis of Valuation
Premium Computation
Page 2 of 15
2001/73247056/00/000
Add on Covers
SRCC Cover
Stamp Duty
Excess
Clauses Description
1.
2.
3.
4.
5.
6.
7.
8.
9.
Warranties Description
1.
2.
3.
4.
5.
6.
Cutting clause: Warranted that the damaged portion should be cut off and the balance utilised.
For imported shipments purchased on CIF basis, where the risk is originating from any Indian port, the coverage will be as per ITC
(B)
It is warranted that if the weight of the cargo exceeds than Registration Laden weight/ Licensed Carrying Capacity of the vehicle, as
mentioned in the Registration Certificate of the vehicle, then any loss or damage arising out of such transit is not covered under the
above mentioned policy
Warranted excluding the risks of loss or damage due to chipping, denting , scratching unless caused by ITC (B) perils.
Warranted that goods are transported in closed wagons and/or trucks to be covered with tarpaulin or any other water proof
material to avoid ingress of water.
warranted that losses due to adulteration, contamination and deteriotation of quality is excluded.
Page 3 of 15
2001/73247056/00/000
Page 4 of 15
2001/73247056/00/000
GIS/MUMBAI-I/1528/2001
AAACI7904GST001
Category
The stamp duty of Rs. 0.50/- paid in cash or by demand draft or by pay order, vide Receipt/Challan No. 2510 dated April 20, 2012. Signed
for and on behalf of the ICICI Lombard General Insurance Company Limited at Mumbai on August 14, 2012.
Page 5 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
2001/73247056/00/000
DECLARATION PROCESS
Dear Insured,
As per terms and condition of Marine Open Policy you are required to furnish declaration for each and every transit to us by 5th of every month for
all the transits commenced in preceding month. The declaration can be submitted to us in following ways:
1.
The certificate of insurance can be directly taken by you from our web based module ie online manager using your user id and
password.
In case if you have not received user id and password, please [email protected] and mention your
Policy No.
2.
Alternatively the declaration can be submitted to us in attached declaration statement on or before 5th of every month for all
transits commenced during the preceding month to the following email id :- [email protected]
The declaration will be uploaded on the online manager and you will receive the confirmation mail for the upload of declaration. We would
like to clarify that no liability shall attach to the Insurer in respect of consignments which are not declared in the specified declaration format by
5th of every month.
Declaration Format
Details
Field
Serial No
Mandatory
Policy No
Mandatory
Amount Declared
Mandatory
Invoice No
Mandatory
LR/RR No
Mandatory
LR/RR Date
Consignee Name
Mandatory
Location From
Mandatory
Location To
Mandatory
Quantity
Mandatory
Description of Cargo
Mandatory
Mode of Conveyance
Optional (Use comma to separate multiple mode of transits : Air, Sea, Road)
Page 6 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
OR
Scope of Cover
Risks Clause
1.
1.2
Sum Insured;
1.3
1.4
of the Schedule.
Exclusions
1.
1.4.1
1.4.2
of the Insured
1.2
1.3
either
1.1
Duration of Transit
1.4
first occur.
The Company shall not be liable for loss, damage or expense
Note :
caused by:
2.1
1.
1.1
belligerent power;
2.2
2.3
1.2
3.2
2.
2.
Claims
Insurable interest
2.1
or civil commotions; or
3.3
3.
time of loss;
2.2
Page 7 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
3.
not with standing that the loss occurred before the contract of
Benefit of Insurance
hereafter:
Not to inure
3.1
other bailee.
4.
report on the occurrence of the loss and extent of the loss, from a
Claim Documents
under the Insurance Act, 1938 and appointed by the Company for
are:
the purpose.
4.1
4.2
abridge the right of the Company to pay or to settle any claim at any
4.3
4.5
4.6
5.
assessor.
Limitation Period
Company shall disclaim liability for any claim hereunder and such
claim shall not within 12 calendar months from the date of the
carriers.
law then the claim shall for all purposes be deemed to have been
abandoned and shall not thereafter be recoverable hereunder.
Claim Procedure
7.
Minimising Losses
7.1
It is the duty of the Insured and their Agents in all cases to take
Duty of Insured
It is the duty of Insured and their servants and agents in
7.1.1
and
5.2
7.1.2
7.2
Waiver clause
Measures taken by the Insured or the Company with the
5.3
Avoidance of Delay
respectively.
Acknowledgement Due
Note :
The Company's liability shall succeed and not in any way supersede
Page 8 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
or civil commotions; or
3.3
Scope of Cover
3.4
1.1
1.2
2.
fire;
Basis of assessment
1.
lightning; or
1.3
2.1
2.2
2.3
1.3
wagon / vehicle.
1.4
Exclusion
1.
1.4.1
1.4.2
of the Insured;
1.2
1.3
1.4
Duration of Transit
either
1.1
1.5
1.6
1.2
1.3
first occur.
Note :
1.
belligerent power;
1.1
2.2
2.3
1.2
3.
2.1
caused by:
2.
2.
3.2
2.
Claims
Insurable interest
2.1
Page 9 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
3.
Note :
insurance, not with standing that the loss occurred before the
The Company's liability shall succeed and not in any way supersede that of the
Benefit of Insurance
Not to inure
Claim Documents
The claim documents which shall be provided in support of a claim are:
4.1
4.2
4.3
4.4
4.5
bailee.
loss and extent of the loss, from a person who holds a license to act as a
Surveyor or loss assessor, under the Insurance Act, 1938 and appointed by the
Company for the purpose.
Provided that nothing hereinabove shall be deemed to take away or abridge the
right of the Company to pay or to settle any claim at any amount
different from the amount assessed by the Surveyor or loss assessor.
6.
4.6
Limitation Period
Company shall disclaim liability for any claim hereunder and such
claim shall not within 12 calendar months from the date of the
law then the claim shall for all purposes be deemed to have been
abandoned and shall not thereafter be recoverable hereunder.
carriers.
5.
This insurance shall not inure to the benefit of the carrier or other
4.
5.3
7.
Minimising Losses
7.1
Claim Procedure
Duty of Insured
It is the duty of Insured and their servants and agents in
It is the duty of the Insured and their Agents in all cases to take
such measures as may be reasonable for the purpose of averting or
7.1.1
and
5.2
Waiver clause
Avoidance of Delay
Page 10 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
Policy.
1.
CONDITION
2.
1.2
Schedule.
Period of Policy
1.3
1.4
Declaration :
Company being bound to accept upto but not exceeding the Sum
Period of Policy
2.1
Railway Receipt;
2.1.2
Lorry Receipt
2.1.3
Postal Receipt;
2.1.4
3.
Sum Insured
3.1
Airway bill;
3.
2.2
2.3
2.4
Details of packing
3.2
3.3
the Schedule.
4.
cease to operate.
Valuation
4.
Declaration Clause
4.1
I of the Schedule.
5.
Cancellation
4.2
days Notice in writing to this effect (except in the case of strike, riot and
civil commotion risks which is subject to 48 hours notice of
5.
in
accordance
with
the
cover granted
Valuation Clause
The shipments insured hereunder are to be valued as specified in Part
when it is issued. But cancellation shall not apply to any risks which
attached
I of the Schedule.
6.
Page 11 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
7.
8.
in the policy shall apply to this extension as if they have been incorporated
Schedule.
herein.
Adjustment Clause
In and with respect to each policy and the subject-matter of insurance, the
1.
Cancellation
This Policy is subject to cancellation by either party on giving 15
2.
Policy conditions."
when it is issued. But cancellation shall not apply to any risks which
have
attached
in
accordance
with
the
3.
4.
balance utilised."
7.
time."
1.3
It is hereby agreed and declared that exclusion under Clause 2 (ii) of Part
1.2
that the exclusion number 2 (iii) of the policy stands deleted, subject
1.1
Cutting clause for goods such as cast iron pipes, asbestos sheets,
etc. : "Warranted that the damaged portion should be cut off and the
Extension
cover granted
2.
1.
For C.I.F value insurance: "Warranted insured value herein does not
exceed C.I.F cost plus ten percent."
recoverable.
Provided always that in no case shall the liability of the Company
exceed the insured value of the complete machine.
9.
Pair and set clause : "Where any item insured under this policy
Exclusions
exceed the value of any particular part or parts which may be lost or
damaged without reference to any special value which such articles may
2.3
have as part of such pair or set and in any event not more than a
covered hereunder is insured for the market value on 'as is where is'
condition."
11.
12.
Page 12 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
4.
The policy shall be null and void and no benefit shall be payable in
accordingly.
3.
Special Provisions
Any special provisions subject to which this policy has been entered
2.
8.
9.
used by the Insured or any one acting on his behalf to obtain any
Reasonable Care
interests of the Insured against accidental loss, or damage that may give
10.
ElectronicTransactions
The Insured agrees to adhere to and comply with all such terms and
Material change
writing of any material change in the risk and cause at his own
give rise to the claim and the Company may, adjust the scope of cover
5.
prescribed from time to time. The Insured agrees that the Company
Records to be maintained
particulars and shall allow the Company to inspect such record. The
Insured shall within one month after the expiry of each period of
insurance furnish such information as the Company may require.
6.
No constructive Notice
Any of the circumstances in relation to these conditions coming to the
knowledge of any official of the Company shall not be the notice to or
7.
11.
Schedule.
11.2
relating to this policy but the receipt of the Insured or his legal
11.3
Page 13 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
14.
Indemnity
the Surveyor.
12.
the sum Insured thereon. If in any case the Company shall be unable
12.1
Subrogation
12.3
12.4
The Insured and any claimant under this policy shall at the expense
or,
subrogated.
16.
then the Company shall not be liable to pay or contribute more than its
If the Insured or any person on his behalf shall not comply with
17.
Right to inspect
behalf shall in case of any loss or any circumstances that have given
Fraudulent claims
If any claim is in any respect fraudulent, or if any false statement, or
13.
Contribution
18.
Cancellation/termination
The Company may at any time, cancel this policy, by giving 7 days
notice in writing by Registered post/Acknowledgement Due post to
the Insured at his last known address in which case the Company
shall be liable to repay on demand a rateable proportion of the
premium for the unexpired term from the date of the cancellation.
The Insured may also give 7 days notice in writing, to the Company,
Page 14 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
19.
for the cancellation of this policy, in which case the Company shall
cancel the policy from the date of receipt of notice and retain the
premium for the period this policy has been in force at the
no.155255.
Policy Disputes
the Schedule to this policy. All claims shall be payable in India in Indian
20.
transit)
Any dispute concerning the interpretation of the terms, conditions,
limitations and/or exclusions contained herein is understood and
This clause shall be paramount and shall override anything contained in this
1.
Renewal notice
1.1
nor give notice that such is due. Every renewal premium (which
Or
1.2
1.3
that may result to enhance the risk of the company under the
the Assured elect to use either for storage other than in the
Or
Notices
1.4
place of discharge,
Whichever shall first occur.
2.
or email.
23.
Customer Service
Institute
Bio-Chemical
Electromagnetic
Grievance Clause
For resolution of any query or grievance, Insured may contact the
Biological,
Chemical,
1.
Page 15 of 15
ICICI Lombard General Insurance Company Limited
Corporate Office : ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025.
1.
weapon.
1.2
1.1
from any nuclear fuel or from any nuclear waste or from the
electronic system.
This Clause shall be paramount and shall override anything contained in this
1.3
1.4
being in the ordinary course of transit and ,in any event ,SHALL
TERMINATE EITHER:
1.1
or
1.2
1.3
purposes.
2.
distribution,
OR
1.4
3.
This warranty would not apply where loss/damage occurred whilst the
discharge.
The cover against strikes, riots and civil commotions risks (as defined in the
relevant SRCC Clauses) may be cancelled by either the Underwriters or the
Assured except in respect of any insurance which shall have attached in