Smoking Questionnaire - Dependant

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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.

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