См. форму "Заявление о выдаче документа, подтверждающего регистрацию в системе индивидуального (персонифицированного) учета (форма АДВ-3)", 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 3
к постановлению Правления
Пенсионного фонда
Российской Федерации
от 31 октября 2022 г. N 243п
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Форма АДВ-3 Код по ОКУД | |
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Заявление о выдаче документа, подтверждающего регистрацию в системе индивидуального
(персонифицированного) учета
Заполняется зарегистрированным лицом печатными буквами
Страховой номер индивидуального лицевого счета ._._._.-._._._.-._._._._._._. Данные, указанные в документе, подтверждающем регистрацию в системе индивидуального (персонифицированного) учета: 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)
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