INSURANCE

YO U A R E M A K I N G

A GOOD
CHOICE!
Your Personalised Quote

ALMOST

5-STAR
CUSTOMER-RATED
INSURANCE

TRUSTED BY
1.5CR CUSTOMERS

4.7/5

*Rated 5/5 on Facebook as on 18th March 2021 and 4.7/5 on Google as on 21st May 2021
*R 021
21
**Across all line of business since inception till 22nd April 2021
GoDigit GI Ltd, Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru
u5560095,
095
Toll Free- 18002585956, www.godigit.com, CIN: U66010PN2016PLC167410, IRDAI Regn No: 158, T&C*
Go Digit, Bharat Griha Raksha Policy

Proposal Form/Quote
UIN: IRDAN158RP0081V01202021
Go Digit General Insurance Ltd
 a. This proposal is for covering Home Building and/or Home Contents against Fire and Allied Perils.

b. Read the Prospectus/Key Features Document/Policy Wordings before filling up this proposal form to understand the
meaning of the terms used herein better.

c. The property proposed for insurance is not covered until the proposal is accepted and premium paid.

For Office Use Only For Partner Use Only

Receipt Intermediary/Agent Name & Code
Proposal No Policy Issuing Office Address & Code
Number (if any)

Atlantis, 95, 4th B Cross Road, Koramangala Industrial DIGIT DIRECT

D051635502
Layout, 5 Block, Bengaluru, Karnataka 560095 1000295
DRSL

A. Details about Proposer and Policy Period

2. Address of the
1. Proposer Name Amit Fcthhgvyv Bengaluru 560059
Proposer

Mobile no +9198786785574
DR 3. Phone Number 4. Email Id gf@hy.com
Landline
J 5. Policy to be issued in favour of (list out all the
parties who have insurable interest) including
the financial institutions

516 From 03-Dec-2021 08:38:57

To 02-Dec-2022 23:59:59
6. Period of Insurance
(Number of Years in case of Long-Term Policy: 365 days)
5167 Note: For Long Term Policy, Period should not exceed 10 years

Nominee Name
7. Nomination Relationship with the
Insured

B. Covers Opted
8. Is there any policy in place for the same property?
If yes, please provide the details

Cover Please tick

9. Cover/s required: When Home Building and Home Contents
J are opted for, cover for General Contents of Home for Sum Home Building & Home
No
Insured equal to 20% of the Sum Insured for Home Building Contents
Cover subject to a maximum of `10 Lakh [Rupees Ten Lakh] is Home Building Only Yes
automatically provided).
Home Contents Only No

C. Location of Home Building

10. Location of Home Building - Full postal address with Pin
hvhxxfg Bengaluru 560059
Code

11. Is it in a Multi-storey building or is it a standalone house

12. In case of multi-storey building, please provide the floor

2
number of Your house

13. Is there a basement to Your house? No

D. Details of Home Building

Please note:

Your Home Building is a building consisting of a residential unit, having an enclosed structure and a roof, basement (if any) and
fixtures and fittings permanently attached to the floor, walls or roof, like fixed sanitary fittings, electrical wiring and other
permanent fittings etc.

It also includes ‘additional structures’ if they are on the same site, are used as part of Your Home Building:

a. garage, domestic out-houses used for residence, parking spaces or areas, if any;

b. compound walls, fences, gates, retaining walls, internal roads;

c. verandah or porch and the like;

d. septic tanks, bio-gas plants, fixed water storage units or tanks, solar panels, wind turbines and air conditioning systems,
central heating systems and the like, if not included in Home Contents Cover, any other structure.

14. Sum Insured (SI) for Home Building: a. SI for residential structure of Your Home including fittings
Please note the following: and fixtures (in `): 9999000
(The amount required to construct Your Home Building at the
policy Commencement Date. This amount is calculated as b. SI for additional structures (in `):
follows:
a. For residential structure of Your Home including fittings and Additional Structure Sum Insured (in Rs)
fixtures:
Carpet area of the structure in square metres X Rate of Cost of
Construction at the policy Commencement Date.
The Rate of Cost of Construction is the prevailing rate of cost
of construction of Your Home Building at the policy
Commencement Date.
b. For additional structures: the amount that is based on the
prevailing rate of cost of construction at the Policy
Commencement Date.)

15. Carpet area of structure of Home in square metres 93 Sq. Mt.

16. Rate of Cost of Construction per square metre at the policy

107516.13 per Sq. Mt.
Commencement Date

Other Details

Less than 5 years 1

5- 10 years
17. Age of Home Building
10- 20 years

Above 20 Years

18. Construction Details Construction*

Please note the following:
(Building(s) having walls and/or roofs of wooden Walls Pucca Construction
planks/thatched leaves and/or grass/hay of any kind/ Floor Pucca Construction
bamboo/plastic cloth/asphalt/ canvas/ tarpaulin and the like
are treated as Kutcha Construction. Roof Pucca Construction
Construction other than Kutcha Construction is a ‘Pucca
Construction’) (*Strike out what is not applicable)

E. Other Details
Please note the following:

i) Home Contents refer to articles or things in Your Home that are not permanently attached or fixed to the structure of Your
Home. Home Contents may consist of General Contents and/or Valuable Contents.

ii) General Contents are all the contents of household use in Your Home, e.g., furniture, electronic items and goods, antennas,
solar panels, water storage equipment, kitchen equipment, electrical equipment (including those fitted on walls), clothing
and apparel and items of similar nature.

iii) Valuable Contents of Your Home consist of items such as jewellery, silverware, paintings, works of art, antique items,
curios and items of similar nature.

iv) If You have opted for Home Building and Home Contents cover, the General Contents of Your home equal to 20% of the
Sum Insured for Home Building Cover subject to a maximum of ` 10 Lakhs (Rupees Ten Lakh) are automatically covered.

Item wise Sum Insured for General Contents (in `):

19. If You want to opt out of in-built cover for General Contents Items Sum Insured
as mentioned in (iv) above and want to have higher Sum
Furniture, Fixtures and Fittings
Insured Or If You have opted for Home Contents Only cover, 3000000
(Home Furnishings)
please provide item wise Sum Insured for General Contents.
(Sum Insured represents Cost of Replacement) Electrical/Electronic

Others

20. In case of Basement, If there are contents in it, please

provide the Sum Insured

F. In-Built Covers (Loss of Rent & Rent for Alternative

Accommodation)
I Sum Insured: ` 0
21.1 Loss of Rent No
II Number of Months:0
 I Sum Insured : ` 0
21.2 Rent for Alternative Accommodation No
II Number of Months :0

Additional Optional Add-on Covers

Sr. Sum Insured/Sum Insured
Name of Add-on Cover Other Details
No. Limits
Incidental Costs (UIN:
1 500000 AOA:AOY basis
IRDAN158RP0081V01202021/A0009V01202122)

Accidental Damage (UIN:

2 500000 AOA:AOY basis
IRDAN158RP0081V01202021/A0007V01202122)

Minor Acquisitions (UIN: 500000% of Total Sum Insured

3 AOA:AOY basis
IRDAN158RP0081V01202021/A0008V01202122) INR 500000

G. Optional Covers (available on payment of additional premium)

No
22. Do You require ‘Personal Accident Cover’ for Yourself and
Your spouse?

23. Do You require ‘Cover for Valuable Contents on Agreed No

Value Basis (under Home Contents cover)’:
(Valuable Contents of Your Home consist of items such as
jewellery, silverware, paintings, works of art, antique items,
curios and items of similar nature.)
(You have to submit a Valuation Certificate. However, the
requirement of valuation certificate is waived if the Sum
Insured opted for is upto ` 5 Lakh and Individual item value
does not exceed ` 1 Lakh).

H. Additional/Add-on Covers (over and above optional covers

available on payment of additional premium)
Sr. No. Name of the Add-On Cover Sum Insured

24.

25.

26.

In Built Cover

Sr. No. Cover Name Sum Insured/ Limit Period Specific Details

Excess: 1% of the claim amount for

Terrorism Damage Cover
each and every claim subject to
1. Endorsement (Material Upto Total Sum Insured -
Minimum of INR 10,000 and
Damage Only)
Maximum of INR 500,000
Storm, Tempest, Flood and
2. Upto Total Sum Insured -
Inundation (STFI)

3. Earthquake Upto Total Sum Insured --

Fees of architect, surveyor,

4. 5% of the claim amount --
consulting engineer

5. Costs of removing debris 2% of the claim amount -

6. Underinsurance 100% waived -

Increase in 10% Home Building

- Sum Insured for long term
7. Escalation Clause policy // Increase by 1/365th of -
10% Home Building - Sum
Insured for annual policy

8. Theft Upto Total Sum Insured - -

9. Forest Fire Upto Total Sum Insured - -

Terrorism cover would not be applicable for the Inbuilt covers listed above (2 to 9)
Specific Warranty
It is hereby declared and agreed that any loss or damage arising out of STFI group of perils, where the same is not excluded,
shall be admissible under the policy only after 5 days starting from the inception date of policy and of the date of inclusion of
new risk location or enhancements of the Sum Insured under the policy.

I. Premium Details
Net Premium (INR) - (a) ` 5524.58
Total Terrorism Premium (INR) - (b) ` 1091.92
Total Optional Cover Premium (INR) - (c) ` 0.00
Total Add-On Premium (INR) - (d) ` 649.95
Total Net Premium (a) + (b) + (c) + (d) ` 7269.45
CGST rate and Amount (INR) -- ` 0.00
SGST/UTGST rate and Amount (INR) -- ` 0.00
IGST rate and Amount (INR) 18 % ` 1308.50
Final Premium ` 8577.95

J. Claims details
Please specify details of any loss to the proposed Property in last 3 years:

Settled Amount/please specify

Date of Loss Cause of Loss Claimed Amount
if claim is outstanding
NA NA

Declaration
• I/ We hereby declare that the statements made by me / us in this Proposal Form are true to the best of my / our knowledge
and belief and I/We hereby agree that this declaration shall form the basis of the contract between me/us and Go Digit
General Insurance Limited.

• If any additions or alterations are carried out in the risk proposed after the submission of this proposal form, then the same
should be conveyed to the insurers immediately.

Date: Signature of the Proposer

Place:

This proposal form has been electronically accepted

Insurance ACT 1938 Section 41- Prohibition of Rebates

No person shall allow or offer to allow either directly or indirectly, as an inducement to any person to take out
or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any
rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor
shall any person taking out or renewing a policy accept any rebate, except such rebate as may be allowed in
accordance with the published prospectus or tables of the insurer. ANY PERSON MAKING FAULT IN
COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH MAY
EXTEND TO TEN LAKHS RUPEES.

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5
Block, Bengaluru, Karnataka 560095, IRDAI Reg No. 158 CIN U66010PN2016PLC167410, GST Reg. No:
33AACCO4128Q1Z7, GSTIN Address: Chennai Business Centre,No 528, Old no.559, Anna Salai, Above
Skoda Showroom, Teynampet,Chennai,Tamil Nadu,PIN-600018. Website: www.godigit.com