{"id":2843,"title":"Digit Total Protect Policy – 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/digit-total-protect-policy-proposal-form.pdf","sha256":"f532b1911b0bbf8323a1fc4ab144c38d1133eb34d651265c7691506b79855e03","pages":5,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals proposing to purchase the Digit Total Protect insurance policy to provide personal, medical, and coverage details required for underwriting and policy issuance.","notes":["If insufficient space, attach separate signed sheet or thumb impression.","Consent required for receiving hard copy of policy; otherwise documents will be shared electronically.","Use clear and legible copies of KYC documents as per IRDAI norms.","Installment payments via ECS or NACH require three installments at policy inception if monthly payment is chosen.","Read declaration carefully before signing.","Insurance Act 1938 Section 41 prohibits rebates as inducements."],"title":"Digit Total Protect Policy – Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Details of Insured Members including the Proposer","fields":[{"help":"Number each insured member starting from 1","type":"number","label":"Member No.","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of each insured member","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Specify relationship to proposer","type":"text","label":"Relationship with Proposer","options":[],"required":true,"pdf_field":""},{"help":"Provide date of birth or age","type":"date","label":"Date of Birth (DD/MM/YY) / Age","options":[],"required":true,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender (M/F/TG)","options":["M","F","TG"],"required":true,"pdf_field":""},{"help":"Provide height in centimeters and weight in kilograms","type":"text","label":"Height (Cms) and Weight (Kgs)","options":[],"required":true,"pdf_field":""},{"help":"Describe occupation/service and mention if involved in hazardous activity or armed forces","type":"text","label":"*Detailed Description of Occupation/Service","options":[],"required":true,"pdf_field":""},{"help":"Enter gross monthly income","type":"amount","label":"Gross Monthly Income","options":[],"required":null,"pdf_field":""},{"help":"Provide ABHA ID if applicable","type":"text","label":"ABHA ID","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Fill sum insured, limits, waiting periods/time excess, co-payment, and other information for each section listed","type":"table","label":"Section with Benefits","options":[],"required":null,"pdf_field":""},{"help":"Select sum insured basis","type":"choice","label":"Individual/Floater Sum Insured Basis","options":["Basis 1","Basis 2"],"required":null,"pdf_field":""},{"help":"Select policy period","type":"choice","label":"Policy Period Options","options":["Less than a year","1 Year","2 Years","3 Years"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Proposer/Policy Holder","fields":[{"help":"Enter full name of proposer","type":"text","label":"Name of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter date of birth","type":"date","label":"Date of Birth (DD/MM/YY)","options":[],"required":true,"pdf_field":""},{"help":"Provide full address","type":"text","label":"Address of Proposer","options":[],"required":true,"pdf_field":""},{"help":"Specify marital status","type":"text","label":"Marital Status","options":[],"required":null,"pdf_field":""},{"help":"Provide mobile number and email address","type":"text","label":"Mobile No & Email ID","options":[],"required":true,"pdf_field":""},{"help":"Enter policy start date","type":"date","label":"*Policy Period From (DDMMYYYY) 00:01 Midnight","options":[],"required":true,"pdf_field":""},{"help":"Select occupation","type":"choice","label":"Occupation","options":["Salaried","Self Employed","Professional","Retired","Student","Housewife","Other"],"required":true,"pdf_field":""},{"help":"Enter PAN number","type":"text","label":"PAN Number","options":[],"required":true,"pdf_field":""},{"help":"If applicable, provide partner code and name","type":"text","label":"Partner Code and Name","options":[],"required":false,"pdf_field":""},{"help":"If applicable, provide partner contact and email","type":"text","label":"Partner Contact and Email ID","options":[],"required":false,"pdf_field":""},{"help":"Provide ABHA ID if applicable","type":"text","label":"ABHA ID (If Applicable)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional details of Disclosure of Each member","fields":[{"help":"Provide details for each member including duration, date of last consultation, treatment details, and result","type":"text","label":"Details of Previous accident or Disability or Pre-existing Illness or Symptoms or Hospitalization or Diagnostic","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Nominee Details","fields":[{"help":"Enter name of insured person","type":"text","label":"Name of Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Enter nominee's name","type":"text","label":"Name of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's mobile number","type":"phone","label":"Mobile number of Nominee","options":[],"required":true,"pdf_field":""},{"help":"Provide nominee's email if available","type":"email","label":"E-mail Id of Nominee","options":[],"required":false,"pdf_field":""},{"help":"Provide nominee's present address","type":"text","label":"Present Address of the Nominee","options":[],"required":true,"pdf_field":""},{"help":"Provide permanent address if different","type":"text","label":"Permanent Address of Nominee (Not required, if same as present address)","options":[],"required":false,"pdf_field":""},{"help":"Specify relationship","type":"text","label":"Relationship of Nominee with Insured Person","options":[],"required":true,"pdf_field":""},{"help":"Provide details if nominee is minor","type":"text","label":"Details of authorized person (If Nominee is minor)","options":[],"required":false,"pdf_field":""},{"help":"Specify percentage share of claim amount","type":"number","label":"Percentage of claim amount","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Bank Account of Nominee","fields":[{"help":"Enter bank account number","type":"text","label":"Bank a/c no.","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Insurance Policy","fields":[{"help":"Indicate if you have other policies","type":"yes-no","label":"Do you have any other Personal Accident Policy or Critical Illness Policy (yes/no)","options":["yes","no"],"required":null,"pdf_field":""},{"help":"Provide policy number if applicable","type":"text","label":"Policy Number","options":[],"required":false,"pdf_field":""},{"help":"Provide sum insured of other policy","type":"amount","label":"Policy Sum Insured","options":[],"required":false,"pdf_field":""},{"help":"Provide insurer name","type":"text","label":"Name of the Insurer","options":[],"required":false,"pdf_field":""},{"help":"Provide insurance period","type":"text","label":"Period of Insurance","options":[],"required":false,"pdf_field":""},{"help":"Provide claim details if any","type":"text","label":"Claims Receivable/Received","options":[],"required":false,"pdf_field":""},{"help":"Provide life insurance details if applicable","type":"text","label":"Details of Life Insurance (If any)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Customer Bank Account Details","fields":[{"help":"Enter your bank account number","type":"text","label":"Bank Account No.","options":[],"required":true,"pdf_field":""},{"help":"Enter bank branch name","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"Enter IFSC code","type":"text","label":"IFSC Code","options":[],"required":true,"pdf_field":""},{"help":"Enter bank name","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"GST & Premium Payment Term Details","fields":[{"help":"Enter GST state code","type":"text","label":"GST State Code","options":[],"required":false,"pdf_field":""},{"help":"Enter GSTIN","type":"text","label":"GSTIN","options":[],"required":false,"pdf_field":""},{"help":"Select premium payment term","type":"choice","label":"Premium Payment Term","options":["Yearly","Half Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Signatures","fields":[{"help":"Enter date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Enter place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Person filling the form must sign and provide name and relationship with proposer","type":"signature","label":"Declaration from Person filling the form in case proposer is unable to sign or signs in vernacular","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Digit Total Protect Policy","attachments":["KYC document","Photograph (not more than 6 months old)","Identity proof document (one from Part A list)","Address proof document (one from Part B list)"],"declarations":["The information provided is true and complete to the best of your knowledge and forms the basis of the insurance policy.","The policy will come into force only after full payment of the premium.","You must notify in writing any change in occupation or health after submission but before risk acceptance.","You consent to the insurer seeking medical and other information for underwriting and claim settlement.","You authorize the insurer to share your proposal information with government or regulatory authorities."],"dropped_labels":5},"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/2843-digit-total-protect-policy-proposal-form"}