Get the free Smoking Status Declaration Form - The Co-operators

Group Benefits smoking status declaration Mailing Address Instructions Mail: Co-operators Life Insurance Company Group Medical Underwriting 1920 College Avenue Regina SK S4P 1C4 Please complete the

How to fill out smoking status declaration form

How to fill out smoking status declaration form:

1. Locate the smoking status declaration form. This form can typically be found at the reception desk or online on the official website of the organization or institution requiring it.
2. Start by providing your personal information. This may include your full name, address, telephone number, and date of birth. Make sure to fill in all the required fields accurately.
3. Move on to the section specifically asking about your smoking status. This may require you to indicate whether you are a current smoker, a former smoker, or a non-smoker. Some forms may also inquire about the number of cigarettes smoked per day or the duration of smoking, so be prepared to provide these details if required.
4. If there are any questions or statements related to secondhand smoke exposure, answer them honestly. This information helps organizations identify potential health risks or concerns related to smoking in their premises or environment.
5. Carefully review the completed form for any errors or missing information. It's crucial to double-check the accuracy of the details provided before submitting the form to ensure it reflects your current smoking status.
6. Sign and date the form as required. Be aware of any additional instructions regarding witness signatures or notarization, as specific rules may apply depending on the organization's policy or legal requirements.

Who needs smoking status declaration form:

1. Individuals applying for employment: Some employers may require candidates to fill out a smoking status declaration form as part of the hiring process to ensure awareness of smoking habits and potential health risks.
2. Public facilities and institutions: Certain public places, such as hospitals, schools, and government buildings, may require visitors or patients to complete a smoking status declaration form to assess the impact of smoking on their premises or to encourage a smoke-free environment.
3. Insurance companies: When applying for life, health, or other forms of insurance, applicants may be required to declare their smoking status to determine policy eligibility and premiums.
4. Research or clinical studies: Participants involved in medical or scientific studies may need to disclose their smoking status to evaluate the impact of smoking on health outcomes or specific research objectives.
5. Landlords or property management firms: Some rental agreements or lease contracts may incorporate a smoking status declaration form to establish the smoking policy within a property or building and ensure compliance with any smoking restrictions or regulations.

For pdfFiller’s FAQs

What is smoking status declaration form?

The smoking status declaration form is a document used to declare an individual's smoking status.

Who is required to file smoking status declaration form?

Any individual who is a smoker or non-smoker and is required to declare their smoking status.

How to fill out smoking status declaration form?

To fill out the smoking status declaration form, the individual needs to provide their personal details and indicate whether they are a smoker or non-smoker.

What is the purpose of smoking status declaration form?

The purpose of the smoking status declaration form is to gather information about an individual's smoking habits for health and insurance purposes.

What information must be reported on smoking status declaration form?

The smoking status declaration form requires the individual to report their smoking status (smoker or non-smoker) and any relevant health information.

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