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NICOTINE USE AFFIDAVIT By signing this form, I certify the following: I have truthfully checked the Yes or No box below that accurately reflects my use of nicotine products in the prior 90 days.q

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How to fill out nicotine use affidavit

01

Obtain a copy of the nicotine use affidavit form from the relevant authority or organization.

02

Read through the form carefully to familiarize yourself with the requirements and instructions.

03

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

04

Provide information about your nicotine use, including the frequency and amount consumed.

05

Sign and date the affidavit in the presence of a witness, if required.

06

Submit the completed form to the appropriate entity for processing.

Who needs nicotine use affidavit?

01

Individuals who are required to provide proof of their nicotine use for legal or administrative purposes.

02

Employers who need to confirm an employee's nicotine use for health insurance or other benefits.

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What is nicotine use affidavit?

Nicotine use affidavit is a form where individuals disclose their nicotine usage.

Who is required to file nicotine use affidavit?

All individuals who use nicotine products are required to file a nicotine use affidavit.

How to fill out nicotine use affidavit?

Nicotine use affidavit can be filled out by providing accurate information about nicotine usage.

What is the purpose of nicotine use affidavit?

The purpose of nicotine use affidavit is to track and monitor nicotine usage among individuals.

What information must be reported on the nicotine use affidavit?

The nicotine use affidavit must include details about the type of nicotine products used and the frequency of usage.

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