Get the free Non-Tobacco User Affidavit Form - Tucson Unified School District

To be completed by Welcome Staff: Date Received Date Entered 2014 2015 Wellness Incentive Program Welcome ID # Non-Tobacco User Affidavit Form Please print clearly. Please keep a copy of all forms

How to fill out non-tobacco user affidavit form

How to fill out non-tobacco user affidavit form:

1. Begin by carefully reading the instructions provided on the form. Make sure you understand the purpose and requirements of the affidavit.
2. Provide your personal information accurately in the designated sections. This typically includes your full name, date of birth, contact information, and social security number.
3. Clearly indicate your intention to certify that you are a non-tobacco user by checking the appropriate box or providing a signed statement.
4. If required, provide additional information or documentation to support your claim of being a non-tobacco user. This may include medical records, self-attestations, or statements from healthcare providers.
5. Review the completed form to ensure all information is accurate and complete. Make any necessary corrections or additions.
6. Sign the form and date it according to the provided instructions.
7. Submit the form as required, either by mailing it to the designated address or by submitting it electronically, depending on the specified method.

Who needs a non-tobacco user affidavit form:

1. Insurance applicants: Some insurance companies and policies offer reduced rates or special benefits to non-tobacco users. In such cases, insurance applicants may need to complete a non-tobacco user affidavit form to provide evidence of their non-smoking status.
2. Job applicants: Certain employers or job positions may require new hires to affirm that they are non-tobacco users. This is often the case in industries where tobacco use may have an impact on job performance or workplace safety.
3. Medical patients: Healthcare facilities or providers, especially those specializing in certain medical procedures, may request patients to provide a non-tobacco user affidavit as part of their medical history. This information helps in determining treatment plans and assessing potential risks associated with tobacco use.
4. Legal purposes: In some legal cases, a non-tobacco user affidavit may be required to provide evidence in matters related to custody battles, adoption processes, or legal disputes involving tobacco use.
5. Others: Depending on specific circumstances, other individuals or organizations may also require a non-tobacco user affidavit form. It is essential to carefully read the instructions or consult the requesting party to determine who needs the form and why.

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