Smoking Questionnaire - Claimant

Form ID
D1359
Audience
General

This form is in connection with your claim for pension and medical treatment - the information you supply will assist in deciding eligibility for benefits.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.

How can I access this form?
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Form (PDF or Word)