{"id":2839,"title":"CORONA KAVACH 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/Corona%20Kavach%20Policy%20Go%20Digit%20-%20%20Proposal%20Form.pdf","sha256":"18488028abc6e7b34848342c173f101f63ed30c1a7d1464badd6587521352e1b","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer to apply for the Corona Kavach insurance policy from Go Digit General Insurance Ltd. The proposer fills it to provide personal, health, and coverage details for insurance underwriting.","notes":["If insufficient space, attach a separate signed sheet.","Policy periods can be 105, 195, or 285 days including a 15-day waiting period.","Sum Insured can be chosen from INR 50,000 to INR 5,00,000 in multiples of INR 50,000.","Use DD/MM/YY format for dates.","Read declaration carefully before signing.","Contact agent or call 1800 258 4242 or email hello@godigit.com for help."],"title":"CORONA KAVACH 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 valid 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 date in DDMMYYYY format","type":"date","label":"Policy Period From DDMMYYYY 00:01 Midnight","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Policy Type Individual / Floater","options":["Individual","Floater"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons to be Insured","fields":[{"help":"Fill details for up to 5 members; Sum Insured in multiples of INR 50,000 from 50,000 to 5,00,000","type":"table","label":"Member No. Full Name Relationship with Proposer Date of Birth (DD/MM/YY) Age Gender (M/F) Height Weight Occupation Nominee/Assignee Name Nominee/Assignee Relationship with Insured Sum Insured* (INR)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Optional cover for daily cash benefit up to 0.5% of Sum Insured per day for max 15 days","type":"yes-no","label":"Hospital daily Cash Opted: Yes/No","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Medical History","fields":[{"help":"Tick Yes/No for each condition and specify member numbers and diagnosis duration","type":"table","label":"Medical History / Habits Yes/No Please Tick the “Member Number“ who had/having mentioned Medical History/Habits Diagnosis Since (In Years)","options":[],"required":true,"pdf_field":""},{"help":"Provide details of illness, symptoms, treatment, doctor and treatment result for each member","type":"text","label":"Any additional details with respect to the questions answered “Yes” in the above table","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Travel History","fields":[{"help":"","type":"yes-no","label":"Have you travelled anywhere internationally in last 21 days? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you had inter-state travel in last 21 days? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"Were you in close proximity of any person with COVID-19? Yes/No","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Premium Payment Details","fields":[{"help":"","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":"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 confirm contents explained and understood","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 on behalf of proposer"}],"deadlines":[],"applies_to":"Corona Kavach Policy (UIN: GODHLIP21074V012021)","attachments":["KYC documents (if applicable)","Separate sheet signed or thumb-impressed if insufficient space for information"],"declarations":["The proposer must disclose all relevant facts affecting the insurance decision.","The policy will be issued only after full premium payment.","The proposer must notify any change in occupation or health after submission but before acceptance.","The company may seek medical information from doctors, hospitals, employers, and other insurers for underwriting and claims.","The company may share proposal and medical information with government or regulatory authorities."],"dropped_labels":2},"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/2839-corona-kavach-policy-go-digit-proposal-form"}