Client Interview Page 4 - Offsets/Rebates A Consultant will contact you upon the completion of the interview
Tax File Number :
Did you have care of a dependent child in 2007?
Did you or your spouse receive FTB through the Family Assistance Office in 2007?
Name of the fund
Membership from
To
Membership Number
Nature of Expense
Out of pocket amount
If yes $......
Place of Residence
Number of Days lived during 2006-2007
If yes total exp $
Name of Dependent
Relationship
Income
Days of Care
% of Contribution