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- Приказ Фонда пенсионного и социального страхования РФ от 30 октября 2023 г. N 2153 "Об утверждении форм и форматов сведений, используемых для регистрации граждан в системе индивидуального (персонифицированного) учета, и порядка заполнения форм указанных сведений"
- Приложение N 1. Форма АДВ-1 "Анкета зарегистрированного лица"
Приложение N 1. Форма АДВ-1 "Анкета зарегистрированного лица"
Приложение N 1
к приказу Фонда пенсионного и социального
страхования Российской Федерации
от 30 октября 2023 г. N 2153
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Форма АДВ-1 Код по ОКУД | |
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Анкета зарегистрированного лица
Заполняется зарегистрированным лицом печатными буквами
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|Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Имя ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Отчество (при ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|наличии) |
|Пол ._. (м/ж) |
|Дата рождения: "._._." ._._._._._._._._. ._._._._. года |
|Место рождения: |
| населенный пункт ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| район ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| регион (область, край, ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| республика,...) |
| страна ._._._._._._._._._._._._._._._._._._._._._. |
|Гражданство ._._._._._._._._._._._._._._._._._._._._._. |
| |
|Адрес индекс ._._._._._._.адрес ._._._._._._._._._._._._._._. |
|постоянного ._._._._._._._._._._._._._._._._._._._._._._._. |
|места жительства ._._._._._._._._._._._._._._._._._._._._._._._. |
| |
|Адрес индекс ._._._._._._.адрес ._._._._._._._._._._._._._._. |
|места ._._._._._._._._._._._._._._._._._._._._._._._. |
|пребывания ._._._._._._._._._._._._._._._._._._._._._._._. |
| (заполнять при отличии от адреса постоянного места жительства) |
| |
|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) ._._._._._._._._._._._._._._._. |
| |
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Дата заполнения Подпись зарегистрированного лица (представителя)
"._._."._._._._._._._._. ._._._._. года _________________________________________________