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

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

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|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) ._._._._._._._._._._._._._._._.           |

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 Дата заполнения                               Подпись зарегистрированного лица (представителя)

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