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GROUP BENEFITS SMOKING STATUS DECLARATION MAILING ADDRESSINSTRUCTIONSMail:Cooperators Life Insurance Company Group Medical Underwriting 1900 Albert Street Regina, SK S4P 4K8Please complete the required

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How to fill out smoking status declaration

01

Start by reading the instructions given on the smoking status declaration form.

02

Fill in your personal details such as your name, date of birth, and contact information.

03

Indicate whether you are a smoker or a non-smoker. If you are a smoker, you may need to provide additional details such as the number of cigarettes smoked per day.

04

Sign and date the form to validate your declaration.

05

Ensure that all the information provided is accurate and truthful before submitting the form.

Who needs smoking status declaration?

01

Anyone who is required to declare their smoking status may need to fill out the smoking status declaration. This can include individuals applying for certain jobs, obtaining insurance policies, or participating in specific programs or activities that require information about an individual's smoking habits.

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What is smoking status declaration?

A smoking status declaration is a formal statement that indicates an individual's smoking habits, typically for medical or insurance purposes.

Who is required to file smoking status declaration?

Individuals applying for certain health insurance policies or those undergoing medical evaluations may be required to file a smoking status declaration.

How to fill out smoking status declaration?

To fill out a smoking status declaration, individuals need to provide their smoking habits, frequency of smoking, and any relevant medical history as required by the form.

What is the purpose of smoking status declaration?

The purpose of a smoking status declaration is to assess risk factors for insurance coverage and to facilitate appropriate medical treatment.

What information must be reported on smoking status declaration?

Individuals must report their current smoking status, frequency of tobacco use, types of tobacco products used, and cessation history if applicable.

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