{"id":2844,"title":"Digit Health Care Plus 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/proposal-form-digit-health-care-plus-policy.pdf","sha256":"0e5e24068fe1eb6aa4b86d4ba998ab4c62c9113484b591ee1322162c8c106040","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by a proposer (individual or family) to apply for the Digit Health Care Plus insurance policy by providing personal, health, and coverage details.","notes":["If insufficient space is available, attach a separate signed sheet.","Period of Insurance can be for 1 to 5 years.","Use DD/MM/YYYY or DD/MM/YY date formats as specified.","Submit KYC documents as per IRDAI norms.","If opting not to receive hard copy of policy, documents will be shared electronically.","Premium payment can be made via Cash, Cheque, DD, Card, ECS or NACH.","If monthly instalment via ECS or NACH is chosen, three instalments must be paid at inception.","Zone based co-pay applies for treatment outside chosen premium payment zone except for accidental injury.","Use block letters and provide accurate contact details.","Declaration must be signed by proposer or authorized person if proposer cannot sign.","No person shall offer or accept rebates except as allowed by insurer's published prospectus."],"title":"Digit Health Care Plus Policy Proposal Form","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","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":"","type":"phone","label":"Mobile No","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Occupation Salaried / Self Employed / Professional / Others","options":["Salaried","Self Employed","Professional","Others"],"required":true,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"First Policy Inception Date DD/MM/YYYY","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email ID","options":[],"required":false,"pdf_field":""},{"help":"Start date and time at midnight","type":"date","label":"*Period of Insurance From DD/MM/YYYY 00:00 Midnight","options":[],"required":true,"pdf_field":""},{"help":"End date and time at 23:59","type":"date","label":"To DD/MM/YYYY 23:59 Midnight","options":[],"required":true,"pdf_field":""},{"help":"Attach KYC document","type":"text","label":"Government ID Proof","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Partner Code and Name","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Partner Contact and Email ID","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Policy Type Individual / Floater","options":["Individual","Floater"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"ABHA ID (If applicable)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Family Composition","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Are You existing Digit Employee / Shareholder (If Yes, please provide details) ___ Yes / ___ No","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever taken any Policy from Us? (If yes, please provide details) ___Yes/ ___ No","options":["Yes","No"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons to be Insured","fields":[{"help":"Fill details for up to 5 members","type":"table","label":"Member No., Full Name, Relationship with Proposer, Date of Birth (DD/MM/YY), Age, Gender (M/F/TG), Height, Weight, Occupation, ABHA ID","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Selection","fields":[{"help":"Fill coverage amounts, limits, waiting periods, deductibles, and specific conditions for each section as applicable","type":"table","label":"Section with Benefits, Sum Insured (INR), Limits, Waiting Periods, Deductible (INR) / Co-Payment (%), Specific Conditions","options":[],"required":true,"pdf_field":""},{"help":"Specify room type if not opting for % of sum insured","type":"text","label":"Room Type Opted","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Cumulative Bonus (if opted) INR","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Health Check up Package Opted","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"No Claim Bonus Benefit INR / %","options":[],"required":false,"pdf_field":""},{"help":"","type":"choice","label":"Option opted: A. Cumulative Bonus / B. No Claim Discount","options":["A","B"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Existing Insurance Policy Details","fields":[{"help":"Provide details for up to 6 existing policies if any","type":"table","label":"Member Number, Do you have any other Health Insurance, Policy Number, Policy Sum Insured, Name of the Insurer, Period of Insurance, Claims Receivable/Received","options":[],"required":false,"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":"","type":"phone","label":"Mobile number of Nominee","options":[],"required":true,"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":"","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":"","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":"Bank Account Details of Nominee","fields":[{"help":"","type":"text","label":"Bank a/c no.","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Customer Bank 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":"","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 Zone & Geographical Limits","fields":[{"help":"Select based on city of residence","type":"choice","label":"Premium Payment Zone: Zone A / Zone B / Zone C","options":["Zone A","Zone B","Zone C"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Geographical Limits Options Within India / Asia / Worldwide Including USA & Canada / Worldwide Excluding USA & Canada","options":["Within India","Asia","Worldwide Including USA & Canada","Worldwide Excluding USA & Canada"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Options for Co-Payment where Geographical Limit is Outside India 0% / 5% / 10% / 15% / 20%","options":["0%","5%","10%","15%","20%"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"GST & Premium Payment Details","fields":[{"help":"","type":"text","label":"GST State Code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"GSTIN","options":[],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Premium Payment Term: Yearly / Half Yearly / Quarterly / Monthly","options":["Yearly","Half Yearly","Quarterly","Monthly"],"required":true,"pdf_field":""},{"help":"","type":"choice","label":"Premium payment mode: Cash/Cheque/DD/Card/ECS","options":["Cash","Cheque","DD","Card","ECS"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Cheque No/NEFT Ref No","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":false,"pdf_field":""},{"help":"Date of payment","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"","type":"amount","label":"Amount (Including applicable taxes)","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Warranty","fields":[{"help":"Sign after reading declaration","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":"Customer Identification Procedure (KYC)","fields":[{"help":"Recent passport size photo not older than 6 months if premium exceeds Rs 100,000","type":"photo","label":"Photograph","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Digit Health Care Plus Policy","attachments":["KYC documents as per Customer Identification Procedure","Photograph (recent passport size)","Identity proof (one from Part A list)","Address proof (one from Part B list)"],"declarations":["The proposer declares that all information provided is true and complete to the best of their knowledge.","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 for underwriting and claims settlement.","The proposer authorizes sharing of proposal and medical information with regulatory authorities."],"dropped_labels":11},"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/2844-digit-health-care-plus-policy-proposal-form"}