Reimbursement Request

Please enable JavaScript in your browser to complete this form.

Your Details - Step 1 of 3

Your details *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Rotary Club *

Club or District Position *

If the claim relates to a District expense, please enter your District Position. If the claim relates to a Club Expense (i.e. District Grant), please enter your Club Position.

What are you claiming? *

Note: you can choose both mileage and a purchase.

What district portfolio does this claim relate to? *

Note: your claim will be sent to the relevant District Chair for approval prior to being sent to the District Treasurer for processing.

What is your Rotary Community Group? *

Is this claim relating to your RCG $1,000 allowance? *

Save and Resume Later

Important information for District Grants

If your claim is for a district grant, you need to enter the full purchase prices on this claim form and then detail the funds received from outside the district towards the grant.

The end claim amount should total the 50% balance of funds remaining to be paid to your club from the district grant.

What is the District Grant Number? *

Item(s) Purchased

Supplier *

Date of purchase *

Amount *

What was purchased and why? *

Supplier

Date of purchase

Amount

What was purchased and why?

Supplier

Date of purchase

Amount

What was purchased and why?

Supplier

Date of purchase

Amount

What was purchased and why?

Supplier

Date of purchase

Amount

What was purchased and why?

Club or other contribution paid towards project

Enter the amount of funds your club has contributed towards the project

District grant funds received to date

Enter the amount of funds that the district paid to your club when the grant was first approved, this should be 50% of the total amount of funds approved.

Total value of items being claimed

This is automatically calculated.

Please upload a copy of ALL suppliers TAX INVOICE/S *

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Note: EFTPOS dockets are not sufficient and without a properly issued TAX INVOICE reimbursement can not be processed.

Important information for Rotary Community Group Allowance Claims

Please complete the provided report form and then upload it here.

Please upload the RCG allowance report and any photos or other items to complete your claim *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Mileage

We reimburse using the standard Australian Taxation Office kilometer rate.

For 2026-2027 the kilometer rate is 91 cents per kilometer.

Where did you travel from?

Where did you travel to?

What was the purpose of your travel? *

What is the total kilometres travelled? *

Dollar value being claimed for mileage

Note: this will be automatically calculated based on the total kilometres travelled and the kilometre rate at the time of submission.

Save and Resume Later

Bank details

Your reimbursement will be paid into the below bank account. Please verify that the details are correct.

BSB *

Account Number *

Account Name *

relate Supplier of

Total amount being claimed

All figures are in AUD only

Signature *

Clear Signature

By signing above, I confirm that the bank details provided are accurate. I understand that if incorrect bank details are supplied, my reimbursement may not be processed. I also confirm that all information provided in this reimbursement form is true and correct to the best of my knowledge.

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

Copy Link

Email *