{"id":2854,"title":"Proposal Form - Digit Life Healthy Glow Policy POS_Sum Assured Above 5L - GODHLIP26044V022526","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-life-healthy-glow-policy-pos-sum-assured-above-5l.pdf","sha256":"c959567974ae3bcd22c0e163907a1953453d42fb5df69481d31e64e33a6fe6a4","pages":19,"collected":"2026-10-17","instructions":{"about":"This form is a proposal for purchasing the Digit Life Healthy Glow Policy, a combined health and life insurance product. It is filled by the proposer who wishes to buy the policy.","notes":["Use DD/MM/YYYY or DD/MM/YY date formats as specified.","If insufficient space, attach separate signed sheet.","Only one photo needed if proposer and life insured are same.","Cheque/DD should be drawn in favor of 'Go Digit Life Insurance Ltd. Proposal Number - <Proposal Number>'.","Premium payment modes include Cash (up to Rs 49,999 at authorized points), Cheque, DD, Card, ECS.","Submit PAN/Form 60 at time of applying.","Original and valid KYC documents must be submitted.","Fill all details honestly and transparently as they will be validated at claim time.","For monthly premium payment by ECS/NACH, three instalments need to be paid at inception.","If proposer is a Non-Profit Organization, provide Niti Ayog Darpan Portal Registration Number if available.","Politically Exposed Persons must disclose details.","If nominee is minor, provide details of authorized person (appointee)."],"title":"Proposal Form - Digit Life Healthy Glow Policy POS_Sum Assured Above 5L - GODHLIP26044V022526","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details and Health Insurance Section","fields":[{"help":"","type":"text","label":"Name of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YY format","type":"date","label":"Date of Birth (DD/MM/YY)","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address of the Proposer","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Marital Status Single / Married","options":["Single","Married"],"required":null,"pdf_field":""},{"help":"Enter mobile number","type":"phone","label":"Mobile No","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Occupation Salaried / Self Employed / Professional / Others","options":["Salaried","Self Employed","Professional","Others"],"required":null,"pdf_field":""},{"help":"Provide PAN, Aadhar or other government ID","type":"text","label":"PAN Number /AADHAR / Government ID Proof","options":[],"required":null,"pdf_field":""},{"help":"Use DD/MM/YYYY format","type":"date","label":"First Policy Inception Date DD/MM/YYYY","options":[],"required":null,"pdf_field":""},{"help":"Enter valid email address","type":"email","label":"Email ID","options":[],"required":null,"pdf_field":""},{"help":"Enter start and end dates in DDMMYYYY format","type":"date","label":"Period of Insurance From DDMMYYYY 00:00 Midnight To DDMMYYYY 23:59 Midnight","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Partner Code and Name","options":[],"required":false,"pdf_field":""},{"help":"Provide contact and email","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":null,"pdf_field":""},{"help":"Describe family members covered","type":"text","label":"Family Composition","options":[],"required":false,"pdf_field":""},{"help":"If available, provide ABHA ID","type":"text","label":"ABHA ID","options":[],"required":false,"pdf_field":""},{"help":"Tick yes or no and provide details if yes","type":"yes-no","label":"Are You existing Digit Employee / Shareholder (If Yes, please provide details) ___ Yes / ___ No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick yes or no and provide details if yes","type":"yes-no","label":"Have you ever taken any Policy from Us? (If yes, please provide details) ___Yes/ ___ No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Do You have or had any retail Policy with Go Digit: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick yes or no","type":"yes-no","label":"Are you enrolled in any of the corporate GMC policy: Yes/No","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Select zone based on city of residence","type":"choice","label":"Premium Payment Zone: Zone 1 / Zone 2","options":["Zone 1","Zone 2"],"required":null,"pdf_field":""},{"help":"Provide bank details for premium payment or claim","type":"text","label":"Customer Bank Details (Bank Account No., Branch, IFSC Code, Bank Name)","options":[],"required":null,"pdf_field":""},{"help":"Sign and date the declaration","type":"signature","label":"Declaration & Warranty on Behalf of All Persons Proposed to be Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Life Insurance Section - Digit Glow Term Life Insurance","fields":[{"help":"Select whose life is insured","type":"choice","label":"Life to be Insured (My life/Someone else's)","options":["My life","Someone else's"],"required":true,"pdf_field":""},{"help":"Provide contact and address details","type":"text","label":"Contact details (Contact number, WhatsApp Number, E-mail ID, Permanent Address, Pin code, Current Address, Pin code)","options":[],"required":true,"pdf_field":""},{"help":"Provide family members' insurance details","type":"table","label":"Additional Insurance Details of Family Members (if Life to be Insured is Housewife or Student)","options":[],"required":false,"pdf_field":""},{"help":"Fill payment details accurately","type":"text","label":"Payment details for the policy (Account Holder’s Name, Account Number, Account Type, UPI ID, IFSC Code, Method of First Deposit, Amount, Cheque/DD details, Mode for Renewal Premium)","options":[],"required":true,"pdf_field":""},{"help":"Select who pays the premium","type":"choice","label":"Who is paying for the premium? (I, the Proposer / Life to be Insured / Third Party)","options":["I, the Proposer","Life to be Insured","Third Party"],"required":true,"pdf_field":""},{"help":"Sign the declaration","type":"signature","label":"Declaration and Authorization","options":[],"required":true,"pdf_field":""},{"help":"Signature of person explaining the form","type":"signature","label":"Declaration (If proposal form is signed in vernacular language / if thumb impression is affixed / filled by person other than proposer or life to be insured)","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Digit Life Healthy Glow Policy (Health Plus Life Combi Product from Go Digit General Insurance Ltd and Go Digit Life Insurance Ltd)","attachments":["KYC document (identity and address proof)","Recent passport size photograph","PAN or Form 60","Medical reports if applicable"],"declarations":["The proposer must disclose all relevant facts affecting the insurance decision.","Consent to receive policy documents electronically if opting out of hard copy.","Declaration & Warranty on behalf of all persons proposed to be insured must be signed.","Vernacular declaration if proposer cannot sign or signs in vernacular.","Section 39 of Insurance Act 1938 applies to nomination.","Section 41 of Insurance Act 1938 prohibits rebates."],"dropped_labels":37},"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/2854-proposal-form-digit-life-healthy-glow-policy-pos-sum-assured-above-5l-godhlip260"}