FORM B. MEMBERSHIP 2022

Complete this form and return to:
The Garden Clubs of Australia Inc.
11 North Terrace,
Dapto NSW 2530

For all enquiries please call the treasurer on 02 4260 8364 or 0408 415 748

Authorise The Garden Clubs of Australia Incorporated, User Id 069621 to arrange for funds to be debited from our account at the financial Institution identified below and as prescribed below through the Bulk Electronic Clearing System.

This authorisation is to remain in force in accordance with the terms described in the attached Direct Debit Request Service Agreement.
We request that you debit our account in accordance with our Agreement.

TO BE COMPLETED BY ACCOUNT SIGNATORIES

Direct Debit payments are for Annual Affiliation Fees, Annual Magazine Subscriptions and Insurance Premiums. Direct debit dates and dollar values will be advised in writing at least 30 days before the due date.

The club acknowledges receiving and reading the Direct Debit Request Service Agreement and agrees to its terms. The Direct Debit arrangements continue until ended as set out in the Service Agreement.

TO BE COMPLETED BY CLUB SIGNATORIES

OFFICE USE ONLY

FORM 2. INSURANCE / RENEWAL 2023/2024

 During February/March 2023 you will receive an Insurance Notice from the GCA for the premium due for your insurance cover for 2023/2024 (4.00pm 30th April 2023 to 4.00pm 30th April 2024). 

 In order that the correct amount is shown on your notice, it is necessary for the GCA to receive your TOTAL MEMBERSHIP number as of 19th February 2023. This number should include all your members you want covered by the GCA Insurance – Members, Life Members, Social Members, Junior Members, Joint Members. NOTE: Insurance invoices will be forwarded in March/April 2023, payment will be debited on or about 21st April 2023. 

When you receive your Certificate of Currency, advise your Club Committee where it is filed and perhaps send the electronic copy to other Executive Committee members. 

PLEASE COMPLETE THIS FORM TO ENSURE ACCURATE COST OF PREMIUM.

DUE DATE: RETURN THIS SECTION BY 19th FEBRUARY 2023.

Please indicate if your club holds large commercial events, for which an additional premium may be required

*A large commercial event is defined as one where more than 1000 non-members attend over the life of the event. Separate cover must be obtained for these events each year. The relevant application form can be found on the GCA web site (www.gardenclubs.org.au) or can be posted on request.

Press submit button below once complete.

Otherwise email completed form to: insurance@gardenclubs.org.au

Or print and post to: Director of Insurance, The Garden Clubs of Australia Inc. 1 Addington Street, Burdell, Qld, 4818

FORM 5. REQUEST FOR REPLACEMENT OF INSURANCE CERTIFICATE OF CURRENCY

 Please Complete the following information 

 I certify that our Club’s CERTIFICATE OF CURRENCY IS LOST and request a replacement Certificate to cover the Club’s activities until April 30th, of the current Insured year. I have paid the fee of $20 as a direct/deposit payment as required: 

 To: GCA BANK ACCT 062000 00922899 

The reference I used in this transaction and recorded on the deposit was: 

Once this form has been submitted a replacement Certificate will actioned then be emailed to your Club Secretary after a replacement Certificate of Currency has been arranged.

Continued Insurance Cover from 30 April
1. You will be required to pay the normal fee for the Insurance Cover based on the number of members that your Affiliated Club has for the next Insurance period. Please complete a GCA Form 2 for the next Insurance period, (for example, 30 April 2021 to 30 April 2022) and send it to the GCA Insurance Officer via email or post.
2. Taking no action means your Club’s membership numbers have not changed and your Club therefore authorises a direct debit for the next Insurance period and the direct debit of the annual GCA Affiliation and Insurance fees.

INSURANCE INCIDENT REPORT FORM

 Please Complete the following information 

IMPORTANT :

A. DO NOT make any public statements or admit fault of any kind. B. DO NOT offer to pay for any expenses incurred.

DETAILS OF INJURED PERSON & THE INCIDENT 

Is the person a financial member of the club

What outward signs were visible in the person?

Normal *
Visible Injury *
In Pain *
Distressed *
the person show any signs of being affected by alcohol and/or drugs? *

For incidents occurring on premises.

Was the accident caused by any foreign matter on the floor? *

• Where possible photograph the place of accident as soon after the incident notating place and time on the rear of photo. • All documentation of the incident must be kept in a safe place for 8 years (or whatever your state limitations are).

Once completed keep this form as your club’s record and send a copy to: 

GCA Insurance 27 Westmorland Drive LEEMING WA 6149 

Or send a scanned copy to insurance@gardenclubs.org.au 

Mobile 0424 430 844 

IF YOU ARE MAKING AN ACTUAL CLAIM YOU NEED TO COMPLETE A CLAIM FORM FROM THE APPROPRIATE INSURER 

You must report any claims made against you and all developments made known to you to the insurer at once and forward any correspondence, unanswered, immediately upon receipt. Likewise any legal proceedings seeking damages such as Writ, Summons, and Statement of Claim should be forwarded to the insurer immediately they are received.