Family Care Expense Form - Union of National Defence Employees

The UNDE fully recognizes that family is not solely defined as consisting of “mother and father with children” and may take several forms including, but not limited to: single parents, same-sex parents, dependent elatives residing in the household.

Please review our Dependent Care Policy prior to filling out this form.

Last Name

First Name

PSAC Number

Street Address

Province

Postal Code

UNDE activity

Title of conference, course, meeting, etc. – please specify.

Caregiver Information

Care provided by

Unlicensed agency/caregiver
Licensed agency/caregiver

Caregiver name

Caregiver address

Caregiver telephone

Fees incurred

Family Member Name

Family Member Relation

Age

Total Hours of Care

Start Date

End Date

Fees Incurred

Attach all supporting documents and receipts.

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as and UNDE

I certify that the above claimed expenses were incurred as a direct result of attending an authorized UNDE activity.

Clear Signature