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AdministrationAFFIDAVIT OF TOBACCO USE FOR EMPLOYMENT I acknowledge that the Snohomish County Health Department is dedicated to providing a healthy, comfortable and tobacco free work environment for

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How to fill out affidavit of non-tobacco use

01

Obtain an affidavit of non-tobacco use form from your employer or insurance company.

02

Fill out your personal information such as name, address, and contact details.

03

Sign and date the affidavit to certify that you do not use tobacco products.

04

Have a witness sign the affidavit to verify your non-tobacco use if required.

05

Submit the completed affidavit to the designated party as per their instructions.

Who needs affidavit of non-tobacco use?

01

Individuals who are applying for health insurance policies that offer lower premiums for non-tobacco users.

02

Employers who require proof of non-tobacco use for their employees' health benefits.

03

Anyone else who needs to provide evidence of their non-tobacco use for various purposes.

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What is affidavit of non-tobacco use?

Affidavit of non-tobacco use is a sworn statement declaring that an individual does not use tobacco products.

Who is required to file affidavit of non-tobacco use?

Employees or individuals who are required to prove their non-tobacco use status by their employers or organizations.

How to fill out affidavit of non-tobacco use?

The affidavit can be filled out by providing personal information, signing and dating the document, and submitting it to the appropriate party.

What is the purpose of affidavit of non-tobacco use?

The purpose of the affidavit is to certify that the individual does not use tobacco products and may be eligible for certain benefits or discounts.

What information must be reported on affidavit of non-tobacco use?

The individual's personal information, declaration of non-tobacco use, and signature are typically required on the affidavit.

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