HEALTH INSURANCE POLICY

Double Wallet Plan

01-

10
500
01-Jan-0001
2
B

Hi, Umang Vinodbhai Chauhan!

Live stress-free because your family's health
is in good hands!

Your Policy Number is D126809295

UIN: GODHLIP23073V012223
Policy Start Date 05-Dec-2023 16:42:49

Policy Expiry Date 04-Dec-2024 23:59:59

Members Insured Bhartiben Umangbhai Chauhan, Umang Vinodbhai Chauhan

 Policy Holder Details

110 BHAGYESHNAGAR NR SANTOSHINAGAR AMRAIWADI AHMEDABAD, Ahmedabad,

Address
380026

Mobile No. +919558049413 Email ID cumang896@gmail.com

RAMESHBHAI
Partner Name VASUDEVBHAI Partner Code 1149379
NARSANGHANI

Partner Contact +919898035777 Partner Email ID vishalfinancialservices@gmail.com

Policy Details

First Policy Inception Date Policy Number D126809295

Policy Issue Date - Policy Type Floater

Family Composition 2 Adult Policy Nature New Business

Premium Payment Zone ZONE 2 Plan Opted Double Wallet Plan

*Based on your city of residence, Zones have been classified into two as mentioned below:

Zone 1: Delhi/NCR, Mumbai including (Navi Mumbai, Thane, and Kalyan) and Greater Hyderabad Area. Zone 2: Rest of India apart from
Zone 1.

As the treatment cost is different in different cities, there are certain conditions if you change your city of treatment:

1. At the time of claim, Insured needs to provide address proof as per the declaration in proposal form.

2. In the absence of Address proof provided which validates the pricing zone opted, and if the place of hospitalization belongs to
Higher Zone Category - then Co-pay of 10% would be applicable on admissible claim amount

3. Zone based Co-Pay, as mentioned above, will not be applicable in case of Accidental Injury.

4. If address proof as per declaration in Proposal form and Address proof provided at the time of claim is same, Zone based Co-pay
will not be applicable.

5. In case of family floater policies, a single zone shall be applied to all the members covered under the policy.

Member Details
1. Full Name Bhartiben Umangbhai Chauhan

DOB 10-May-1995 Age / Gender 28 / Female

Member ID N0292741780 Relationship with the Proposer Spouse

Height (cm) / Weight (Kg) 159 cm / 52 kg First Policy Inception Date

Umang Vinodbhai Nominee Relationship with

Nominee Name Husband
Chauhan Insured

2. Full Name Umang Vinodbhai Chauhan

DOB 10-Aug-1985 Age / Gender 38 / Male

Member ID N0081334491 Relationship with the Proposer Self

Height (cm) / Weight (Kg) 153 cm / 65 kg First Policy Inception Date

Bhartiben Umangbhai Nominee Relationship with

Nominee Name Wife
Chauhan Insured

Sum Insured (SI)

 Additional Sum
Cumulative Cumulative Effective
Insured Name Base Sum Insured Insured
Bonus (%) Bonus* Sum Insured
(At Renewals)

Bhartiben
Umangbhai
Chauhan
5,00,000 ` Ď 5,00,000
Umang
Vinodbhai
Chauhan

*Cumulative Bonus will be applicable as per your opted plan. In case of an individual policy, cumulative bonus will not be accumulated
at the end of the year for all the new members added during the policy.
• In case of portability all the waiting period applicable under this policy shall be counted from First Policy Inception date for each
member for Sum Insured existing with the previous insurer.
• Fresh waiting periods will be applied on Enhanced Sum Insured opted with Go Digit at the time of porting the policy

Policy Coverage Details

Section Sum Insured (`)

No. of Limits Deductible/ Specific Terms &
Coverages
Policy (excluding cumulative Co-payments Conditions
Wordings bonus)

1 Hospitalization Cover ₹ 5,00,000 NA

No room rent
1.1 In-Patient Hospitalization Cover ₹ 5,00,000*
restrictions

1.2 Day Care Procedures* ₹ 5,00,000* NA

1.3 Pre-Hospitalization ₹ 5,00,000* 30 Days

1.4 Post-Hospitalization ₹ 5,00,000* 60 Days

1% of base Sum
1.5 Road Ambulance ₹ 5,000* Insured max upto
INR 10,000
NA
1.6 Bariatric Surgery ₹ 5,00,000* NA

1.7 Psychiatric Illness ₹ 5,00,000* NA

0.25% of base
Sum Insured,
1.8 Health Check-up ₹ 1,000** max upto INR
1,000 after every
two year

1.9 Home (Domiciliary) Hospitalization ₹ 5,00,000* NA

2 Organ Donor Expenses ₹ 5,00,000* NA

6 Sum Insured Back-up ₹ 5,00,000 NA

7 In-built Personal Accident ₹ 50,000** NA

*These Sum Insureds will be part of Section 1 - Hospitalization Cover Sum Insured
**These Sum Insured will be over and above Section 1 - Hospitalization Cover Sum Insured

Cumulative Bonus 10% of base Sum Insured for every claim free year, max up to 100%

Waiting Period Options - Year 1

 Initial
Waiting Pre-existing Worldwide Specific
Maternity Critical Illness
Member Period Disease Cover Disease
Waiting Waiting
Name and ID (excluding Waiting Waiting Waiting
Period Period
critical Period Period Period
illness)

Bhartiben Umangbhai
30 Days Initial
Chauhan- 30 Days 3 Years NA NA 2 Years
waiting period
N0292741780

Umang Vinodbhai
30 Days Initial
Chauhan- 30 Days 3 Years NA NA 2 Years
waiting period
N0081334491

1. All the waiting period applicable under this policy shall be counted from First Policy Inception date for each member for Sum
Insured existing with the previous insurer

2. Fresh waiting periods will be applied on Enhanced Sum Insured opted with Go Digit at the time of porting the policy.

Medical History
Bhartiben Umangbhai Chauhan
Any Pre-Existing Disease? No

Do you have Thyroid? No

Do you have Diabetes? No

Do you have Asthma? No

Do you have Hypertension? No

Do you have Hyperlipidemia? No

Are you on any ongoing medications? No

Any Gynaecological problem No

Any undiagnosed symptoms? No

Umang Vinodbhai Chauhan

Any Pre-Existing Disease? No

Do you have Thyroid? No

Do you have Diabetes? No

Do you have Asthma? No

Do you have Hypertension? No

Do you have Hyperlipidemia? No

Are you on any ongoing medications? No

Any undiagnosed symptoms? No

*Symptoms[Fever,Cough,Shortness of breath, Malaise(flu-like tiredness),Rhinorrhoea(mucus discharge from the nose),Sore

throat,nausea, vomiting and/or diarrhoea or Influenza like illness]Personal Habit.

Personal Habits
Bhartiben Umangbhai Chauhan
Do you consume tobacco? No

Do you consume alchohol? No

Umang Vinodbhai Chauhan
Do you consume tobacco? No

Do you consume alchohol? No

Premium Details

Description Amount (INR)

Base Premium 10970.00

Underwriting Loading NA

City Discount (-10%) -1097.00

Net Premium 9873.00

CGST @ 9% = (889.00) + SGST/UTGST @9% = (889.00) 1778.00

Final Premium 11651.00

Payment Details

GST State Name Gujarat GSTIN

Receipt No. - Receipt Date -

Invoice No. - Invoice Date -

Mode of Payment Bank Name

Instrument Details Premium Payment Term Yearly

Date Amount Paid

For policies issued via installment - In case the installment is not received by the due date, insured will have 5 days
grace period, but no claims shall be admissible during the grace period. If premium is not received with in the grace period also, policy
will automatically be cancelled.

Final confirmation before we start our relationship

1. You agree on your behalf and on behalf of all members proposed to be insured, that the above statements, answers and/or
particulars given by you are true and complete in all respects to the best of your knowledge and that you are authorized to propose
on behalf of the other members.

2. You understand that the information provided by you will form the basis of the insurance policy and is subject to the Board
approved underwriting policy of the insurer and that the policy will come into force only after full payment of the premium
chargeable.

3. You further declare that you will notify in writing any change occurring in the occupation or general health of the life to be
insured/proposer after the proposal has been submitted but before communication of the risk acceptance by us.

4. You declare that you give consent to us seeking medical information from any doctor or hospital who/which at any time has
attended on the person to be insured/proposer or from any past or present employer concerning anything which affects the
physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for
insurance on the person to be insured /proposer has been made for the purpose of underwriting the proposal and/or claim
settlement.

5. You authorize us to share information pertaining to your proposal including the medical records of the insured/proposer for the sole
purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.

6. By submitting your contact number and email ID, you authorize Go Digit General Insurance (Digit Insurance) to call, send SMS,
messages over internet-based messaging application like WhatsApp and email and offer you information and services for the
product(s) you have opted for as well as other products/services offered by Digit Insurance. Please note that such authorization will
be over and above any registration of the contact number on TRAI’s NDNC registry.
 This document has been electronically signed by the Proposer

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.

Wish to go through your detailed policy, click here

For Any Queries

1800 258 4242 hello@godigit.com

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. 29AACCO4128Q1ZW, HSN: 997133 / General Insurance
Services, GSTIN Address: Go Digit General Insurance Limited, Atlantis No 95, 4th B Cross Road 5th Block Koramangala Industrial layout,
Bengaluru Karnataka PIN-560095.Website: www.godigit.com