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Tobacco User Certification Statement Medicare Supplemental Policy The questions and statements below pertain to the Applicant. Smoking and/or use of tobacco products means any use of cigarettes, pipes,
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How to fill out non-tobacco user certification statement
To fill out a non-tobacco user certification statement, follow these steps:
01
Obtain the necessary form: Contact your insurance provider or employer to request the non-tobacco user certification form. They will provide you with the appropriate document.
02
Read the instructions carefully: Thoroughly review the instructions provided with the form. Make sure you understand the requirements and any supporting documentation that may be needed.
03
Provide personal information: Fill in your personal details accurately, such as your name, address, date of birth, and contact information. Double-check for any errors before moving on to the next step.
04
Indicate tobacco usage: On the form, you will typically find a section where you have to indicate whether you are a tobacco user or non-tobacco user. If you are a non-tobacco user, mark the appropriate box or provide the required information as requested.
05
Sign and date the form: At the end of the non-tobacco user certification statement, you will likely need to provide your signature and date. Ensure you sign the form using your legal signature and provide the current date.
06
Submit the form: Once you have completed the form, follow the instructions to submit it. This may involve mailing the form, dropping it off in person, or submitting it electronically, depending on the instructions provided by the insurance provider or employer.
6.1
Non-tobacco user certification statements may be required by various entities, such as insurance providers and employers. The purpose of this statement is to gather information about whether an individual uses tobacco or not. Typically, individuals who are non-tobacco users are eligible for lower insurance premiums or certain employment benefits. Therefore, individuals seeking lower insurance rates or specific workplace benefits may need to provide a non-tobacco user certification statement. If you are uncertain of whether you need to provide this certification, it is best to contact your insurance provider or employer directly for clarification.
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What is non-tobacco user certification statement?
Non-tobacco user certification statement is a document certifying that an individual does not use tobacco products.
Who is required to file non-tobacco user certification statement?
Non-tobacco user certification statement must be filed by individuals who do not use tobacco or tobacco-related products.
How to fill out non-tobacco user certification statement?
To fill out a non-tobacco user certification statement, individuals must provide their personal information and sign the document to certify that they do not use tobacco products.
What is the purpose of non-tobacco user certification statement?
The purpose of a non-tobacco user certification statement is to verify and confirm that an individual is a non-tobacco user for various purposes such as insurance or employment.
What information must be reported on non-tobacco user certification statement?
The non-tobacco user certification statement must include the individual's personal information, signature, and affirmation that they do not use tobacco products.
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