Приложение 1. Форма АДВ-1 "Анкета зарегистрированного лица"

ГАРАНТ:

См. форму "Анкета зарегистрированного лица (форма АДВ-1)", утвержденную приказом Социального фонда России от 30 октября 2023 г. N 2153

См. порядок заполнения формы

См. данную форму в редакторе MS-Excel и образец ее заполнения

Приложение 1
к постановлению Правления
Пенсионного фонда
Российской Федерации
от 31 октября 2022 г. N 243п

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Форма АДВ-1                                                       Код по ОКУД      |          |

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Анкета зарегистрированного лица

Заполняется зарегистрированным лицом печатными буквами

Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
Имя ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
Отчество (при наличии)._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
Пол ._. (м/ж)
Дата рождения "._._." ._._._._._._._._. ._._._._.года
Место рождения:
город (село,
деревня,...) ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
район ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
регион (область,
край, республика, ...) ._._._._._._._._._._._._._._._._._._._._._._._._._._._.
страна ._._._._._._._._._._._._._._._._._._._._._.
Гражданство ._._._._._._._._._._._._._._._._._._._._._.
Адрес индекс ._._._._._._. адрес ._._._._._._._._._._._.
регистрации ._._._._._._._._._._._._._._._._._._._._._.
._._._._._._._._._._._._._._._._._._._._._.
Адрес места индекс ._._._._._._. адрес ._._._._._._._._._._._.
жительства ._._._._._._._._._._._._._._._._._._._._._.
фактический ._._._._._._._._._._._._._._._._._._._._._.
(заполнять при отличии от адреса регистрации)
Телефоны ._._._._._._._._._._._._._._._._._._._._._._.
(домашний и/или рабочий)
Документ, удостоверяющий личность
Вид документа ._._._._._._._._._._._._._._._._._._._._ ._._._._._._._._._._._._._._._._._._._.
(указать название документа: паспорт, удостоверение личности или другие документы, удостоверяющие
личность)
Серия, номер ._._._._._._._._._._._._._._._._._._.
Дата выдачи "._._."._._._._._._._._._._._._._._. года
Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._.
._._._._._._._._._._._._._._._._._._._._._._._._._.
Реквизиты акта гражданского состояния о рождении
Номер актовой записи о рождении ._._._._._._._._._._._._._._._._._._._._._._._._._.
Дата составления актовой записи о рождении "._._."._._._._._._._._._._._._._._. года
Наименование органа, которым произведена государственная регистрация акта о рождении._._._._._._.
._._._._._._._._._.._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
Идентификационный номер налогоплательщика (при наличии) ._._._._._._._._._._._._._._._.

 Дата заполнения                               Подпись зарегистрированного лица (представителя)

 "._._."._._._._._._._._._._._._._._. года     __________________________________________

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