This page contains forms for download relating to the District Insurance Policy,

Stallholders Insurance, and links for assistance with Travel Insurance.

The District Insurance Officer is John Giuricin Mob: 0419 303 050 or
Please contact John Giuricin well in advance of any event.
This comprehensive document has been prepared by District Insurance Officer John Giuricin.
There are significant "deductibles" in all sections of the policy, payable by your club in the event of a claim.
All Club Presidents, Club Insurance Officers and other Club Officers should download a copy and be fully aware of the contents.
An updated definition of “Who is Insured”  under the Rotary Insurance program.
The second bullet point is where issues arise, clubs not declaring their events are not meeting the agreement
and consequently are not insured, the same for the last Paragraph.
ANNUAL CLUB DECLARATION
Rotary Club Insurance Compliance Declaration Form 2022-2023- MUST be completed by March 4 2022 - Download the Excel file, complete the document, save to your computer, email to District Insurance Officer John Giuricin -
 
ROTARY YOUTH VOLUNTEER INFORMATION AND DECLARATION FORM
(Please note - after entering details in the PDF document, to save the document it must be given a new name)
MEETING ATTENDANCE FORM
Clubs must record attendance of all members and guests at every regular meeting.
The Meeting Attendance Record Form is a blank PDF with writable fields. It may be printed blank and used as a hand completed form, or Club and members names can be added and saved using your club name for the document.
It can then be completed online and saved for each meeting with the date of the meeting in this format - YYYY-MM-DD which files in the correct order.
EVENT ATTENDANCE
AND INCIDENT LOG
Clubs must record attendance of all members and volunteers at events, activities, sausage sizzles.
A record must be made of all incidents, even if no claim is expected.
EVENT MANAGEMENT
Click on the form, it will open in your browser, complete the questions.
Use the Save function to download the completed form to your computer. 
The Save function of Chrome looks like a small downward arrow
Other web browsers will have a similar function, normally in the upper right corner. 
Save the form to a location you can easily find and include your club name and date in the File Name so that the DIO knows who sent the document.
Attach the document/s to an email to District Insurance Officer John Giuricin at insurance@rotary9640.org
 
Rotary Insurance Pro Forma - Complete all sections
Rotary Risk Management Form - Complete all sections (6 pages)
 
Rotary General Release and Indemnity Form - As this form requires signatures, download after completing and save.
Open PDF software such as Adobe Acrobat or Reader to add the signatures.
Next attach the form to an email to District Insurance Officer.
 
MARKET STALLHOLDERS EVENTS INFORMATION
As a Rotary Club you have cover under The Rotary Insurance Program however the Public Liability Policy has a Market Activities Endorsement and therefore it is the intention of the Public Liability policy only to pick up Rotary’s vicarious liability. It excludes cover arising from, or caused by, individual market stall operators, and only applies to Rotary’s activities as an event holder if they are found negligent. Please read the full details below:-
 
 
Stallholders are able to purchase this cover online, (phone or tablet if at the market already) and have it issued on the spot.
Use this web address - https://mymarketinsurance.com.au/stall-holders/
Below is a direct link to My Market Insurance:-