Get the free 2013 Non-Tobacco User Affidavit Form - Dallas County

DALLAS COUNTY 2013 NON-TOBACCO USER AFFIDAVIT Name: Please print. Social Security Number (last four digits) Date of Birth To support the overall health and wellness of its employees and retirees (and

How to fill out 2013 non-tobacco user affidavit

1. To fill out the 2013 non-tobacco user affidavit, begin by obtaining the necessary form. This form is typically provided by the organization or entity that requires proof of non-tobacco use.
2. Read through the form carefully to understand the information and documentation required. The form will usually ask for personal details such as name, address, and contact information.
3. Look for the section specifically related to tobacco use or non-use. This section will typically include questions about your tobacco use history, such as whether you currently use tobacco products or have used them in the past.
4. Answer each question on the form truthfully and accurately. If you are a non-tobacco user, mark the appropriate box or provide the necessary information to indicate your non-tobacco use status.
5. If required, attach any supporting documents that may be necessary to prove your non-tobacco use. This can include documentation from healthcare providers, cessation programs, or any other relevant evidence.
6. After completing the form and attaching any required documents, review your answers and ensure that all information provided is accurate and up-to-date.
7. Finally, sign the affidavit, certifying that the information provided is true and accurate to the best of your knowledge. Some organizations may require you to have the form notarized, so make sure to follow any additional instructions provided.

The 2013 non-tobacco user affidavit may be required by various organizations or entities. Some common examples include:

1. Insurance companies: Insurance providers may require non-tobacco user affidavits to determine premium rates for health, life, or other types of insurance policies. This is because tobacco use is often associated with higher health risks and potential health complications.
2. Employers: Some employers, especially those with smoke-free policies or health promotion programs, may request non-tobacco user affidavits as part of the hiring process or to qualify for certain benefits, such as reduced health insurance rates.
3. Educational institutions: Certain academic programs, scholarships, or housing options within universities or colleges may require non-tobacco user affidavits. This is particularly common in institutions that prioritize promoting a healthy and smoke-free environment.
4. Government agencies: Government organizations or agencies may request non-tobacco user affidavits for various purposes, such as eligibility for certain programs or to qualify for discounts or benefits.

It is important to note that the specific requirements for the 2013 non-tobacco user affidavit may vary depending on the organization or entity requesting it. Always carefully review the instructions provided with the form and ensure that you provide accurate and truthful information.

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What is non-tobacco user affidavit form?

Non-tobacco user affidavit form is a document where an individual attests that they do not use tobacco products.

Who is required to file non-tobacco user affidavit form?

Non-tobacco users who are asked to provide proof of their non-use of tobacco products may be required to file the affidavit form.

How to fill out non-tobacco user affidavit form?

To fill out the non-tobacco user affidavit form, individuals must provide their personal information and attest to their non-use of tobacco products by signing and dating the form.

What is the purpose of non-tobacco user affidavit form?

The purpose of the non-tobacco user affidavit form is to provide proof that an individual does not use tobacco products.

What information must be reported on non-tobacco user affidavit form?

The information reported on the non-tobacco user affidavit form typically includes the individual's full name, contact information, and a statement attesting to their non-use of tobacco products.