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NICOTINE USE QUESTIONNAIRE To be completed by Proposed Insured Name: 1. Did you use any of the following within the last 12 months? Cigarettes Cigars, cigarillos Pipe Chewing tobacco, The Patch, Nicoletta
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Who needs a recind questionnaire form:
01
Individuals who have received a request to fill out the form from a relevant organization, such as a government agency or educational institution.
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It may be required for individuals who need to formally rescind or withdraw a previous application, request, or agreement.
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Certain legal or regulatory processes may also necessitate the completion of a recind questionnaire form. It is advisable to check with the specific entity or authority requiring the form to determine if it is applicable to your situation.
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