{"id":2836,"title":"Arogya Sanjeevani Policy, Go Digit - 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-arogya-sanjeevani-policy-go-digit.pdf","sha256":"817a4d5f329f488f3e2c77c1aae3300f30fd2a3f7c02a61e07a4fd07ac407305","pages":3,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer (person seeking insurance) to apply for health insurance under the Arogya Sanjeevani Policy by Go Digit General Insurance Ltd. The proposer provides personal, medical, and nominee details to enable underwriting and policy issuance.","notes":["If insufficient space, attach a separate signed sheet or thumb impression.","Consent required for receiving hard copy of policy; else documents will be sent electronically.","Contact agent or call 1800 258 4242 or email healthclaims@godigit.com for help.","Use DD/MM/YY format for dates.","Declaration must be read carefully before signing.","Insurance Act 1938 Section 41 prohibits rebates as inducements."],"title":"Arogya Sanjeevani Policy, Go Digit - Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Use DD/MM/YY format","type":"date","label":"Date of Birth (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Address of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status Single / Married","options":["Single","Married"],"required":true,"pdf_field":""},{"help":"Enter 10-digit mobile number","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Occupation Salaried / Self Employed / Professional / Other","options":["Salaried","Self Employed","Professional","Other"],"required":true,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Enter start and end dates in DDMMYYYY format","type":"date","label":"Period of Insurance From DDMMYYYY 00:00 Midnight To DDMMYYYY 23:59 Midnight","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Policy Type Individual / Floater","options":["Individual","Floater"],"required":true,"pdf_field":""},{"help":"Provide ABHA ID if available","type":"text","label":"ABHA ID (If Applicable)","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Premium Payment Frequency Yearly/ Half Yearly/ Quarterly/ Monthly","options":["Yearly","Half Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons to be Insured","fields":[{"help":"Fill details for up to 5 members; include all columns as listed","type":"table","label":"Member No. Full Name Relationship with Proposer Date of Birth (DD/MM/YY) Age Gender (M/F) Height Weight Occupation ABHA ID Sum Insured (INR)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical History","fields":[{"help":"For each medical history/habit question, tick Yes/No, specify member numbers affected, and duration in years","type":"table","label":"Have any of the person proposed to be insured ever suffered from / are suffering from any of the following and/or having any of the habits mentioned below: Please tick 'YES' for insured wherever applicable and provide details in the table below","options":[],"required":true,"pdf_field":""},{"help":"Provide detailed information for each member with 'Yes' answers","type":"table","label":"Any additional details with respect to the questions answered “Yes” in the above table: Member Number Details of Illness with Symptoms Date of Last Consultation Treatment Details with Treating Doctor Details Result of the Treatment (Ongoing/Complete Recovery/ Recurrent or like to Recur)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Customer Bank Account Details","fields":[{"help":"","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code of the bank branch","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment Details","fields":[{"help":"Provide cheque number or NEFT reference number","type":"text","label":"Cheque No/NEFT Ref No","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Total premium amount paid","type":"amount","label":"Amount (Including applicable taxes)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"","type":"text","label":"Name of Insured Person","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Enter 10-digit mobile number","type":"phone","label":"Mobile number of Nominee","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"E-mail Id of Nominee","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Present Address of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Fill only if different from present address","type":"text","label":"Permanent Address of Nominee (Not required, if same as present address)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Relationship of Nominee with Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Provide details if nominee is a minor","type":"text","label":"Details of authorized person (If Nominee is minor)","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage share for nominee","type":"number","label":"Percentage of claim amount","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Warranty","fields":[{"help":"Sign after reading declaration carefully","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration from Person filling the form (if proposer unable to sign or signs in vernacular)","fields":[{"help":"Sign to certify explanation of form contents","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name & Relationship with Proposer","options":[],"required":true,"pdf_field":""},{"help":"","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Place","options":[],"required":true,"pdf_field":""}],"filled_by":"person filling form"}],"deadlines":[],"applies_to":"Arogya Sanjeevani Policy health insurance proposals","attachments":["KYC documents (if applicable)","Separate sheet signed or thumb-impressed if insufficient space for information"],"declarations":["The proposer declares all information is true and complete to the best of their knowledge and is authorized to propose for all persons insured.","The information provided forms the basis of the insurance policy and the policy is effective only after full premium payment.","The proposer will notify any change in occupation or health after submission but before risk acceptance.","The proposer consents to the insurer seeking medical and insurance information from doctors, hospitals, employers, and other insurers for underwriting and claims.","The proposer authorizes sharing of proposal and medical information with government and regulatory authorities for underwriting and claims."],"dropped_labels":1},"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/2836-arogya-sanjeevani-policy-go-digit-proposal-form"}