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120Statement of Health Principal Life Insurance Company Des Moines, IA 503920002PLEASE USE BLACK INK PLEASE ENTER DATES AS MM/DD/YYY Account number Instructions 1. The Employee Information section
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How to fill out principal statement of health

01
Obtain the principal statement of health form from the appropriate institution or organization.
02
Fill out all personal information including full name, date of birth, address, and contact information.
03
Provide details of any pre-existing medical conditions or medications currently being taken.
04
Answer all health-related questions honestly and accurately.
05
Review the completed form for any errors or missing information before submitting.

Who needs principal statement of health?

01
Individuals applying for certain insurance policies or financial products may be required to provide a principal statement of health.
02
Students enrolling in certain educational programs or participating in sports activities may also need to submit a principal statement of health.
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Principal statement of health is a form that provides information about an individual's current health condition.
Individuals who are applying for certain insurance policies or benefits may be required to file a principal statement of health.
Principal statement of health can be filled out by providing accurate and detailed information about one's current health status.
The purpose of principal statement of health is to assess an individual's health risk and determine their eligibility for insurance coverage or benefits.
Information such as medical history, current medical conditions, medications, and lifestyle habits may need to be reported on the principal statement of health form.
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