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    DEVELOPMENT OFFICER LIC OF INDIA
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    This document is a merchant marine questionnaire from Life Insurance Corporation of India. It collects information from an applicant such as the type of vessel they serve on, the country of registration, tonnage, cargo carried, job title, duties, and operating areas. The applicant must declare that all statements are true or the insurance contract will be void.

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    lic marine form

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    This document is a merchant marine questionnaire from Life Insurance Corporation of India. It collects information from an applicant such as the type of vessel they serve on, the country of registration, tonnage, cargo carried, job title, duties, and operating areas. The applicant must declare that all statements are true or the insurance contract will be void.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    85 views1 page

    Marine

    Uploaded by

    DEVELOPMENT OFFICER LIC OF INDIA
    This document is a merchant marine questionnaire from Life Insurance Corporation of India. It collects information from an applicant such as the type of vessel they serve on, the country of registration, tonnage, cargo carried, job title, duties, and operating areas. The applicant must declare that all statements are true or the insurance contract will be void.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    LIFE INSURANCE CORPORATION OF INDIA

    MERCHANT MARINE QUESTIONNAIRE

    Proposal No_____________________ Form No. LIC03 - 507

    Name of the Proposer______________________________________________

    1. On what type of vessel do you normally


    serve?
    Cargo, passenger, container, etc

    2. In what country is the vessel registered?

    3. What is the gross tonnage of the vessel?

    4. What type of cargo does the vessel carry?

    5. What is your specific job title?

    6. What are your precise duties?

    7. In what areas does the vessel operate?


    If this includes the Middle East area, Please
    give full details

    DECLARATION

    I ___________________________________________ do hereby declare that the


    foregoing statements and answers are true in every particular and agree and declare that
    these statements and this declaration along with my Proposal for Insurance and the
    Declaration relative thereto shall form the basis of the contract between me and the Life
    Insurance Corporation of India and that if any untrue averment be contained therein the
    said contract shall be absolutely null and void and moneys which shall have been paid in
    respect thereof shall stand forfeited to the Corporation.

    Dated at _____________on the _________day of _____________200

    Signature of Witness__________________
    Occupation
    Address Signature of the Life to be assured

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