{"id":2847,"title":"Digit Donor Shield 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-donor-shield-policy.pdf","sha256":"3c36c38243f956bf3a6cf1a4248eb2cbc94adc4417f12fe9a0968ca65349c634","pages":4,"collected":"2026-10-17","instructions":{"about":"This form is used by the proposer to apply for the Digit Donor Shield insurance policy, providing personal, nominee, and coverage details.","notes":["If insufficient space, attach a separate signed sheet or thumb impression.","Period of Insurance limited to 3 years for Surrogacy Cover and 1 year for Oocyte Donor cover.","Use DD/MM/YYYY format for dates.","Submit KYC documents as per IRDAI norms.","Instalment payments require three instalments at policy inception if using ECS or NACH.","Original bills and documents must be valid and effective as on date of claim submission.","Use block letters where applicable."],"title":"Digit Donor Shield 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/YYYY format","type":"date","label":"Date of Birth (DD/MM/YYYY)","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":"Provide any government ID proof number","type":"text","label":"PAN Number /AADHAR / Government ID Proof","options":[],"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","type":"date","label":"Period of Insurance From DD/MM/YYYY 00:00 Midnight","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 Fresh/Renewal/Roll-Over /Migration/Portability","options":["Fresh","Renewal","Roll-Over","Migration","Portability"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Family Composition","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"ABHA ID","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Details of Persons to be Insured","fields":[{"help":"Fill details for each member to be insured","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 Details","fields":[{"help":"Select the coverage sections you want to opt for","type":"checkbox","label":"Please tick for the sections you want to opt","options":["SECTION 1- IN PATIENT HOSPITALIZATION","A. Surrogacy Cover","A1. Pre / Post Hospitalization Expenses","A2. Road Ambulance","A3. Alternate Treatment (Ayush) Benefit","B. Oocyte Donor","B1. Pre / Post Hospitalization Expenses","B2. Road Ambulance","B3. Alternate Treatment (Ayush) Benefit","SECTION 2 - CARDIAC AMBULANCE","SECTION 3 - OPD CONSULTATION WITH GYNAECOLOGIST","SECTION 4 - DAY CARE TREATMENT","SECTION 5 - MODERN TREATMENT","SECTION 6 - ROOM RENT MODIFICATION","SECTION 7 - WELLNESS BENEFIT PROGRAM"],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in INR","type":"amount","label":"Sum Insured (INR)","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Limits","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Waiting Periods","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Deductible (INR) / Co-Payment (%)","options":[],"required":false,"pdf_field":""},{"help":"","type":"text","label":"Specific Conditions","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":"Enter percentage share of claim amount","type":"number","label":"Percentage of claim amount","options":[],"required":true,"pdf_field":""},{"help":"Provide bank account number, IFSC code, branch, and bank name","type":"table","label":"Details of Bank Account of Nominee","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Questions for Oocyte Donor","fields":[{"help":"","type":"yes-no","label":"Do you have any existing illness or health conditions? Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"yes-no","label":"The health condition may have been treated/ diagnosed in the past or being treated currently, including any gynecological issues, if relevant- Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Provide details if answered Yes above","type":"text","label":"Please provide details","options":[],"required":false,"pdf_field":""},{"help":"","type":"yes-no","label":"Have you ever been a donor before? - Yes / No","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Any other details/conditions need to be disclosed","options":[],"required":false,"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":"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":"","type":"text","label":"Premium Payment Term","options":[],"required":false,"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":"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":"Place of signing","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":"Date of declaration","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of declaration","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Sign here if proposer cannot sign","type":"signature","label":"Signature (on behalf of the Proposer)","options":[],"required":true,"pdf_field":""},{"help":"Name and relation to proposer","type":"text","label":"Name & Relationship with Proposer","options":[],"required":true,"pdf_field":""}],"filled_by":"person filling form"}],"deadlines":[],"applies_to":"Digit Donor Shield Policy proposals","attachments":["KYC document","Separate sheet if insufficient space for information","Clear and legible copy of one document each from Part A (Identity proof) and Part B (Address proof) if premium exceeds Rs 100,000","Recent passport size photograph (not more than 6 months old) if premium exceeds Rs 100,000"],"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 policy will be issued based on the information provided and is subject to underwriting and 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."],"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 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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/2847-digit-donor-shield-policy-proposal-form"}