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Client Interview Page 4 - Offsets/Rebates
A Consultant will contact you upon the completion of the interview

Tax File Number  :
Mobile Number    :  
 
T1) Do you have a dependent spouse (without dependent child or student), a housekeeper? Yes
No
Family Tax Benefit (FTB):

Did you have care of a dependent child in 2010?



Yes
No

Did you or your spouse receive FTB through the Family Assistance Office in 2010?

Yes
No
T2. Have you been in prison for the whole year : Yes
No

 
T5. Did you have private health insurance in 2010?

Name of the fund

Membership from

To

Membership
Number


T6) Did you receive Child Care Benefit and have out of pocket expenses during the 2009 Yes
No

Nature of Expense

Out of pocket amount

 

 

 

 


T7) Do you have a child that was born or adopted between 1 July 2001 and 30 June 2004? Yes
No
Please Call Centrelink
T8)Did you make superannuation contributions on behalf of a spouse? Yes
No

If yes $......
T9)Did you live in a remote area of Australia or serve overseas with the Australian defence Yes
No

Place of Residence

Number of Days lived during 2009-2010


T10) Did you have net medical expenses over $1,500? Yes
No

If yes total exp $


T11) Did you maintain a parent, spouse’s parent or invalid relative?

Name of Dependent

Relationship

Income

Days of Care

% of Contribution

  

 
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 NHTAA, 52 Carl Street, WOOLOONGABBA, QLD 4102 Phone: 07-33913980 Fax: 1300 88 29 00 email: info@nhtaa.com.au