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)