Information if you're affected by coronavirus (COVID-19).
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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