Smoking Questionnaire - Dependant

Form ID: 
D1219
Audience: 
General

This form is in connection with your claim for pension and medical treatment. The information supplied will assist in deciding eligibility for benefits under the Veterans’ Entitlements Act 1986 and/or Military Rehabilitation and Compensation Act 2004.

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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