{"id":2,"title":"No Claim Discount (Add on Cover under Individual Health Insurance Products) UIN: GODHLIA26040V022526 – Proposal Form","purpose":"proposal","insurer":{"slug":"go-digit-general-insurance","name":"Go Digit General Insurance Limited"},"source_pdf":"https://www.godigit.com/content/dam/godigit/directportal/en/downloads/health/proposal-form-no-claim-discount-individual-revision.pdf","sha256":"c998fb6b7947a52ab04f587d31e33863cedf6b5bc82a9f1be49e992814153bd5","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for proposing the No Claim Discount add-on cover under individual health insurance products offered by Go Digit General Insurance Ltd. It is filled by the proposer who holds the base health insurance policy.","notes":["Instalment can be paid through ECS or NACH; if monthly instalment is allowed, three instalments must be paid at policy inception.","Please read declaration carefully before signing.","Insurance Act 1938 Section 41 prohibits rebates as inducements for insurance policies.","Declaration from person filling the form is required if proposer is unable to sign or signs in vernacular."],"title":"No Claim Discount (Add on Cover under Individual Health Insurance Products) UIN: GODHLIA26040V022526 – Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name of Base Health Product to which this add on cover will be attached","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Policy Number of Base Health Product","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Select one option applicable if no claim in expiring policy","type":"choice","label":"Please select type of No Claim Bonus You want to opt for (applicable only in case of no claim in the expiring policy)","options":["No Claim Discount","Cumulative Bonus"],"required":null,"pdf_field":""},{"help":"Provide details of the No Claim Bonus opted","type":"text","label":"Please mention details of No Claim Bonus opted","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Special Terms and Exclusions","fields":[{"help":"Special terms and exclusions as applicable","type":"text","label":"1.","options":[],"required":false,"pdf_field":""},{"help":"Special terms and exclusions as applicable","type":"text","label":"2.","options":[],"required":false,"pdf_field":""}],"filled_by":""},{"title":"GST & Premium Payment Details","fields":[{"help":"Enter GST state code","type":"text","label":"GST State Code","options":[],"required":null,"pdf_field":""},{"help":"Enter GST Identification Number","type":"text","label":"GSTIN","options":[],"required":null,"pdf_field":""},{"help":"As per base product with which this add-on cover is filed","type":"text","label":"Premium Payment Term","options":[],"required":null,"pdf_field":""},{"help":"Select mode of premium payment as per base product","type":"choice","label":"Premium payment mode: Cash/Cheque/ DD/Card/ECS","options":["Cash","Cheque","DD","Card","ECS"],"required":null,"pdf_field":""},{"help":"Enter cheque number or NEFT reference number","type":"text","label":"Cheque No/NEFT Ref No","options":[],"required":null,"pdf_field":""},{"help":"Enter name of the bank","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Enter total premium amount including taxes","type":"amount","label":"Amount (Including applicable taxes)","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Warranty","fields":[{"help":"Date of signing declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration from Person filling the form in case proposer is unable to sign or signs in vernacular","fields":[{"help":"Date of declaration","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of declaration","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of person filling the form","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":null,"pdf_field":""},{"help":"Name and relationship to proposer","type":"text","label":"Name & Relationship with Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"person filling the form"}],"deadlines":[],"applies_to":"Add-on cover to individual health insurance products","attachments":["Relevant details with regard to add on cover to be attached with proposal form of the base product"],"declarations":["The statements and particulars given are true and complete to the best of the proposer's knowledge and the proposer is authorized to propose on behalf of all persons to be insured.","The information provided forms the basis of the insurance policy and the policy is effective only after full payment of premium.","The proposer will notify in writing any change in occupation or health after submission of proposal but before risk acceptance.","The proposer consents to the insurer seeking medical information from doctors, hospitals, employers, and other insurers for underwriting and claim settlement.","The proposer authorizes the insurer to share proposal and medical information with governmental and regulatory authorities for underwriting and claims settlement."],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"hello@godigit.com","label":"Customer Happiness Team Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"d App\n37K+ Reviews\nRated App\n7K+ Reviews\nDownload Digit App\nSelect Preferred Language\n×\nLogin\nDigit General\n70260 61234\nhello@godigit.com\naccount_circle\nMy Policy\nLogout\n70260 61234\nhello@godigit.com\nOur WhatsApp number cannot be used for calls. This is a c","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-258-5956","label":"Customer Support Phone","level":null,"hours":"24/7","applies_to":"all","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"ppiness team through any of the following options.\nEmail us at\nhello@godigit.com\n(Response in 3 days)\nCall us at\nMotor: 1800-258-5956\nHealth: 1800-258-4242\n(Available 24/7).\nChat with our expert on\n7026061234\n(All days, 09 am to 10 pm)\nTo read the Digit","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-258-4242","label":"Customer Support Phone","level":null,"hours":"24/7","applies_to":"all","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"ny of the following options.\nEmail us at\nhello@godigit.com\n(Response in 3 days)\nCall us at\nMotor: 1800-258-5956\nHealth: 1800-258-4242\n(Available 24/7).\nChat with our expert on\n7026061234\n(All days, 09 am to 10 pm)\nTo read the Digit Protection of Policyh","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"7026061234","label":"Chat with expert phone","level":null,"hours":"09 am to 10 pm","applies_to":"all","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"om\n(Response in 3 days)\nCall us at\nMotor: 1800-258-5956\nHealth: 1800-258-4242\n(Available 24/7).\nChat with our expert on\n7026061234\n(All days, 09 am to 10 pm)\nTo read the Digit Protection of Policyholder Interest\r\n                      Policy –\nClick","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"address","value":"Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru 560095","label":"Grievance Redressal Officer Address","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"y Policy\nCIN: L66010PN2016PLC167410, IRDAI Reg. No. 158.\nGo Digit General Insurance Limited | Corporate Office Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru 560095 | Registered Office Address: 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, Shivaji Nagar,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"grievance@godigit.com","label":"Grievance team email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"Team will review your complaint and provide you with a\r\n                        resolution within 14 days.\nEmail us at\ngrievance@godigit.com\nSubmit your Grievance\nClick Here\nEmail at\ncomplaints@irdai.gov.in\nRegister your complaint online at\nhttps://bimabharosa","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"adish.kanna@godigit.com","label":"Nodal Officer Andhra Pradesh, Telangana, Tamil Nadu & Andaman","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"here\nDetails of Nodal Officers\nAndhra Pradesh , Telangana , Tamil Nadu & Andaman\nAdish Kanna\nadish.kanna@godigit.com\nDelhi-NCR\nHemant Kumar\nhemant.kumar@godigit.com\nGujarat\nSandeepkumar Tiwari\nsandeepkumar.tiwari@godigit.com\nChhattisgar","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"hemant.kumar@godigit.com","label":"Nodal Officer Delhi-NCR","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"l Officers\nAndhra Pradesh , Telangana , Tamil Nadu & Andaman\nAdish Kanna\nadish.kanna@godigit.com\nDelhi-NCR\nHemant Kumar\nhemant.kumar@godigit.com\nGujarat\nSandeepkumar Tiwari\nsandeepkumar.tiwari@godigit.com\nChhattisgarh & Bihar\nSudhir Tiwari\nsudhir.tiwari@godigit.co","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"sandeepkumar.tiwari@godigit.com","label":"Nodal Officer Gujarat","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"Andaman\nAdish Kanna\nadish.kanna@godigit.com\nDelhi-NCR\nHemant Kumar\nhemant.kumar@godigit.com\nGujarat\nSandeepkumar Tiwari\nsandeepkumar.tiwari@godigit.com\nChhattisgarh & Bihar\nSudhir Tiwari\nsudhir.tiwari@godigit.com\nKarnataka & Kerala\nSasi Jayaram\nSasi.Jayaram@godigit.com\nM","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"sudhir.tiwari@godigit.com","label":"Nodal Officer Chhattisgarh & Bihar","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"hemant.kumar@godigit.com\nGujarat\nSandeepkumar Tiwari\nsandeepkumar.tiwari@godigit.com\nChhattisgarh & Bihar\nSudhir Tiwari\nsudhir.tiwari@godigit.com\nKarnataka & Kerala\nSasi Jayaram\nSasi.Jayaram@godigit.com\nMumbai\nYogesh R Yarde\nyogesh.yarde@godigit.com\nPunjab, Himacha","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"Sasi.Jayaram@godigit.com","label":"Nodal Officer Karnataka & Kerala","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"epkumar.tiwari@godigit.com\nChhattisgarh & Bihar\nSudhir Tiwari\nsudhir.tiwari@godigit.com\nKarnataka & Kerala\nSasi Jayaram\nSasi.Jayaram@godigit.com\nMumbai\nYogesh R Yarde\nyogesh.yarde@godigit.com\nPunjab, Himachal Pradesh, Haryana (Except Gurgaon), Jammu & Kashmir\nHart","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"yogesh.yarde@godigit.com","label":"Nodal Officer Mumbai","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"Sudhir Tiwari\nsudhir.tiwari@godigit.com\nKarnataka & Kerala\nSasi Jayaram\nSasi.Jayaram@godigit.com\nMumbai\nYogesh R Yarde\nyogesh.yarde@godigit.com\nPunjab, Himachal Pradesh, Haryana (Except Gurgaon), Jammu & Kashmir\nHartej Singh\nhartej.singh@godigit.com\nRajasthan, Ma","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"hartej.singh@godigit.com","label":"Nodal Officer Punjab, Himachal Pradesh, Haryana (Except Gurgaon), Jammu & Kashmir","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"ogesh R Yarde\nyogesh.yarde@godigit.com\nPunjab, Himachal Pradesh, Haryana (Except Gurgaon), Jammu & Kashmir\nHartej Singh\nhartej.singh@godigit.com\nRajasthan, Madhya Pradesh\nVipin Tyagi\nvipin.tyagi@godigit.com\nRest of Maharashtra (except Mumbai), Goa\nAshwin Deokar\nas","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"vipin.tyagi@godigit.com","label":"Nodal Officer Rajasthan, Madhya Pradesh","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":", Haryana (Except Gurgaon), Jammu & Kashmir\nHartej Singh\nhartej.singh@godigit.com\nRajasthan, Madhya Pradesh\nVipin Tyagi\nvipin.tyagi@godigit.com\nRest of Maharashtra (except Mumbai), Goa\nAshwin Deokar\nashwin.deokar@godigit.com\nUttar Pradesh and Uttarakhand\nRahul Tr","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ashwin.deokar@godigit.com","label":"Nodal Officer Rest of Maharashtra (except Mumbai), Goa","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"om\nRajasthan, Madhya Pradesh\nVipin Tyagi\nvipin.tyagi@godigit.com\nRest of Maharashtra (except Mumbai), Goa\nAshwin Deokar\nashwin.deokar@godigit.com\nUttar Pradesh and Uttarakhand\nRahul Tripathi\nrahul.tripathi@godigit.com\nWest Bengal, Jharkhand, Odisha and North East\nA","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"rahul.tripathi@godigit.com","label":"Nodal Officer Uttar Pradesh and Uttarakhand","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"f Maharashtra (except Mumbai), Goa\nAshwin Deokar\nashwin.deokar@godigit.com\nUttar Pradesh and Uttarakhand\nRahul Tripathi\nrahul.tripathi@godigit.com\nWest Bengal, Jharkhand, Odisha and North East\nAshwani Kumar Chouhan\nashwani.chouhan@godigit.com\nNodal Officers Detail p","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ashwani.chouhan@godigit.com","label":"Nodal Officer West Bengal, Jharkhand, Odisha and North East","level":null,"hours":null,"applies_to":"all","source_url":"https://www.godigit.com/claims","quote":"tarakhand\nRahul Tripathi\nrahul.tripathi@godigit.com\nWest Bengal, Jharkhand, Odisha and North East\nAshwani Kumar Chouhan\nashwani.chouhan@godigit.com\nNodal Officers Detail pertaining to Third Party Motor Accidents Claims\nState\nNodal Officer\nEmail ID\nGeneric Email Id\nHi","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-258-5956","label":"Motor helpline for complaints","level":null,"hours":"24/7","applies_to":"motor","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"ppiness team through any of the following options.\nEmail us at\nhello@godigit.com\n(Response in 3 days)\nCall us at\nMotor: 1800-258-5956\nHealth: 1800-258-4242\n(Available 24/7).\nChat with our expert on\n7026061234\n(All days, 09 am to 10 pm)\nTo read the Digit","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-258-4242","label":"Health helpline for complaints","level":null,"hours":"24/7","applies_to":"health","source_url":"https://www.godigit.com/claim/grievance-redressal-procedure","quote":"ny of the following options.\nEmail us at\nhello@godigit.com\n(Response in 3 days)\nCall us at\nMotor: 1800-258-5956\nHealth: 1800-258-4242\n(Available 24/7).\nChat with our expert on\n7026061234\n(All days, 09 am to 10 pm)\nTo read the Digit Protection of Policyh","fetched_at":"2026-10-20"}],"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/go-digit-general-insurance/2-no-claim-discount-add-on-cover-under-individual-health-insurance-products-uin-go"}