Get the free Non-tobacco User Affidavit

This affidavit certifies that the signer is not a tobacco user and has not used tobacco products in the past 12 months, essential for securing non-tobacco user discounts on insurance applications.

How to fill out non-tobacco user affidavit

How to fill out non-tobacco user affidavit

1. Obtain the non-tobacco user affidavit form from the relevant authority or website.
2. Read the instructions carefully to understand the requirements.
3. Fill out your personal information in the designated sections, including your name, address, and date of birth.
4. Indicate your non-tobacco user status by selecting the appropriate option or answering the relevant questions.
5. If required, provide any supporting documentation that verifies your non-tobacco use.
6. Review the completed affidavit for accuracy and completeness.
7. Sign and date the affidavit where indicated.

Who needs non-tobacco user affidavit?

1. Individuals applying for health insurance that offers discounts for non-tobacco users.
2. Employees participating in workplace wellness programs that require a non-tobacco user declaration.
3. Applicants for certain state or local government benefits that promote healthy lifestyles.

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What is non-tobacco user affidavit?

A non-tobacco user affidavit is a legal document that certifies an individual's status as a non-tobacco user, often required by employers or insurance companies to potentially qualify for lower premiums.

Who is required to file non-tobacco user affidavit?

Typically, employees who choose to participate in certain health insurance plans or receive benefits related to wellness programs are required to file a non-tobacco user affidavit.

How to fill out non-tobacco user affidavit?

To fill out a non-tobacco user affidavit, individuals must provide personal information, declare their non-tobacco usage, and often sign the document to affirm its accuracy.

What is the purpose of non-tobacco user affidavit?

The purpose of the non-tobacco user affidavit is to identify individuals who do not use tobacco products, thereby allowing them to access discounts or benefits on health insurance premiums.

What information must be reported on non-tobacco user affidavit?

The information typically reported includes the individual's name, date, signature, and a declaration of non-tobacco usage, along with any other required personal details.