2022 District Insurance Programme Information
About your District and its Clubs and Club Trusts
Your District Name *
Country *
Type of organisation *
Total number of members (being your Clubs) as at 1 July 2021 *
Total number of Rotarians and Rotaractors in the District *
Approximate annual revenue of the District to 30 June 2021 *
Asset insurance *
Insurance History - claims *
| No Claims made | Claim made | |
|---|---|---|
| Claim based on negligence or other failure to carry out duties | ||
| Claim for loss of property, monies or investment | ||
| Claim for cyber loss | ||
| Claim by employee | ||
| Claim by member, shareholder or beneficiary | ||
| Claim by minor or their guardian relating to any duty of care or protection | ||
| Claim for damage to others property including motor vehicles | ||
| Claim relating to any organised event or project run tby the organisation |
If other, please specify:
Is there situation that you think might give rise to a claim? *
If yes or NOT sure, please specify:
The full name of the person completing *
The person completing's title or role *
Date completed *
Your email address please *
The mobile number for the person completing and any other way you can be contacted *
Privacy and your Responsibility
Do you agree that the answers are provided are based on the Rotary International Privacy Policy attached to the survey *
On insurance information you understand that the information must be true and correct *
If other, please specify:
You have not suppressed, misrepresented or misstated any relevant fact. *
If other, please specify: