Заявление об обмене страхового свидетельства (Форма АДВ-2)
Код по ОКУД |
Заявление об обмене страхового свидетельства
Заполняется застрахованным лицом печатными буквами.
┌──────────────────────────────────────────────────────────────────────────────────────────────┐
│ 0 0 1 - 0 0 1 - 0 5 5 9 4 │
│Страховой номер ._._._._._._._._._._._._._._. │
│Ф.И.О., указанные в страховом свидетельстве │
│ П Е Т Р О В А │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ Е Л Е Н А │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ В Л А Д И М И Р О В Н А │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Новые анкетные данные (указать только изменившиеся данные) │
│ Г А Л К И Н А │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.│
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.│
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.│
│Дата рождения "._._." ._._._._._._._._._ ._._._._. года │
│ город (село, дер., ...) ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ район ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ область (край, респ., ...) ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ страна ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Гражданство ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Адрес постоянного места жительства │
│Адрес индекс ._._._._._._. адрес ._._._._._._._._._._._._._. │
│регистрации ._._._._._._._._._._._._._._._._._._._._._._._._. │
│ ._._._._._._._._._._._._._._._._._._._._._._._._. │
│Адрес места индекс ._._._._._._. адрес ._._._._._._._._._._._._._._._._. │
│жительства ._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │
│фактический ._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ (заполнять при отличии от адреса регистрации) │
│Телефоны ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ (домашний и/или рабочий) │
│Документ, удостоверяющий личность │
│ П А С П О Р Т Р О С С И И │
│Вид документа ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ (указать название документа: паспорт, удостоверение │
│ личности и другие документы, удостоверяющие личность) │
│ 3 3 9 7 1 1 8 7 9 2 │
│Серия, номер ._._._._._._._._._. ._._._._._._. │
│ 1 8 Ф Е В Р А Л Я 2 0 0 0 │
│Дата выдачи "._._." ._._._._._._._._. ._._._._. года │
│ 3 4 О М г М О С К В Ы │
│Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ ._._._._._._._._._._._._._._._._._._._._._._._._._. │
└──────────────────────────────────────────────────────────────────────────────────────────────┘
Дата заполнения Личная подпись
2 1 Ф Е В Р А Л Я 2 0 0 0 ГАЛКИНА
"._._." ._._._._._._._._. ._._._._. года застрахованного лица -------
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- Жилищный кодекс (ЖК РФ)
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- Уголовный кодекс (УК РФ)
- Бюджетный кодекс (БК РФ)
- Арбитражный процессуальный кодекс
- Конституция РФ
- Земельный кодекс (ЗК РФ)
- Лесной кодекс (ЛК РФ)
- Семейный кодекс (СК РФ)
- Уголовно-исполнительный кодекс
- Уголовно-процессуальный кодекс
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- О персональных данных
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- О средствах массовой информации
- Производственный календарь на 2024 год
- Федеральный закон "О полиции" N 3-ФЗ
- Расходы организации ПБУ 10/99
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