{"id":2846,"title":"Saral Suraksha Bima, Go Digit – Proposal Form (GODPAIP21616V012021)","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-saral-suraksha-bima-go-digit.pdf","sha256":"e06f837bbb88137b80409f39834502df164d57ec862fd78eb969732a3b71d139","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals (proposers) to apply for the Saral Suraksha Bima insurance policy from Go Digit General Insurance Ltd. The proposer fills it to provide personal, policy, insured persons, coverage, nominee, and payment details for the insurance proposal.","notes":["Read the Prospectus/CIS/Policy Wordings before filling the form.","Company liability starts only after proposal acceptance and premium payment.","If hard copy of policy documents is required, provide consent; else documents will be shared electronically.","Premium instalments via ECS/NACH require three instalments at inception if monthly mode chosen.","Use clear and legible copies of KYC documents as per IRDAI norms if premium exceeds Rs 100,000.","Customer Identification Procedure requires one document each from Part A (Identity) and Part B (Address) plus recent photograph.","Failure to comply with Insurance Act 1938 Section 41 on rebates is punishable by fine up to ten lakh rupees."],"title":"Saral Suraksha Bima, Go Digit – Proposal Form (GODPAIP21616V012021)","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Policy Details","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"First Policy Inception Date","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY 00:01 Midnight","type":"date","label":"Policy Period From","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile No","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Partner Code","options":[],"required":false,"pdf_field":""},{"help":"","type":"email","label":"Email Id","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Partner Contact No.","options":[],"required":false,"pdf_field":""},{"help":"Provide government issued ID proof","type":"text","label":"Government ID Proof","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Birth","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Marital Status","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"Partner Email id","options":[],"required":false,"pdf_field":""},{"help":"Provide detailed description of occupation/service including hazardous activity or armed forces involvement","type":"text","label":"Occupation","options":[],"required":null,"pdf_field":""},{"help":"Specify family members composition","type":"text","label":"Family Composition","options":[],"required":null,"pdf_field":""},{"help":"If applicable, provide ABHA ID","type":"text","label":"ABHA ID (If Applicable)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Insured Person Details","fields":[{"help":"Number assigned to each insured member","type":"number","label":"Member No.","options":[],"required":null,"pdf_field":""},{"help":"Full name of insured person","type":"text","label":"Full Name","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YY or age","type":"date","label":"Date of Birth (DD/MM/YY)/ Age","options":[],"required":null,"pdf_field":""},{"help":"Select gender","type":"choice","label":"Gender (M/F/TG)","options":["M","F","TG"],"required":null,"pdf_field":""},{"help":"Provide detailed occupation and risk class","type":"text","label":"Detailed Description of Occupation/ Risk Class","options":[],"required":null,"pdf_field":""},{"help":"Provide gross monthly income","type":"amount","label":"Gross Monthly Income","options":[],"required":null,"pdf_field":""},{"help":"If applicable, provide ABHA ID","type":"text","label":"ABHA ID","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Coverage Details","fields":[{"help":"Number of dependent children for Education Grant cover (child aged ≤ 25 years and full-time student)","type":"number","label":"Number of Dependent Child***","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional details of Insured Persons","fields":[{"help":"Columns: Member Number, Details of previous accident/disability/illness/symptoms/hospitalization/diagnostic, Duration, Date of Last Consultation, Treatment Details with Treating Doctor, Result of Treatment (Ongoing/Complete Recovery/Recurrent or like to Recur)","type":"table","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":"For each nominee: Bank account no., IFSC code, Branch, Bank Name","type":"table","label":"Details of Bank Account of Nominee","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Customer Bank Details","fields":[{"help":"","type":"text","label":"Bank Account No.","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Bank Name","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"GST & Premium Payment Details","fields":[{"help":"","type":"text","label":"GST State Code","options":[],"required":false,"pdf_field":""},{"help":"","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":null,"pdf_field":""},{"help":"Select mode of premium payment","type":"choice","label":"Premium payment mode","options":["Cash","Cheque","DD","Card","ECS"],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration & Warranty","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Sign after reading declaration carefully","type":"signature","label":"Signature of the Proposer","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Vernacular Declaration","fields":[{"help":"Date of signing","type":"date","label":"Date","options":[],"required":null,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":null,"pdf_field":""},{"help":"Signature of person explaining form","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":null,"pdf_field":""},{"help":"Name and relationship of person signing on behalf","type":"text","label":"Name & Relationship with Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"person filling form if proposer unable to sign"}],"deadlines":[],"applies_to":"Saral Suraksha Bima insurance policy proposals","attachments":["Photograph (not more than 6 months old, if premium exceeds Rs 100,000)","One document from Part A (Identity proof)","One document from Part B (Address proof)"],"declarations":["The statements and particulars given are true and complete to the best of my knowledge and I am authorized to propose on behalf of all persons insured.","The policy will come into force only after full payment of premium and acceptance of proposal.","I will notify any change in occupation or health after submission but before risk acceptance.","I consent to the company seeking medical and insurance information for underwriting and claim settlement.","I authorize sharing of proposal and medical information with government and regulatory authorities.","I confirm to have chosen the correct occupation and will inform the company of any changes during policy or renewal."],"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/2846-saral-suraksha-bima-go-digit-proposal-form-godpaip21616v012021"}