Приложение 1. Анкета зарегистрированного лица (Форма АДВ-1)

Анкета зарегистрированного лица

Заполняется печатными буквами

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│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │

│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │

│Отчество (при наличии) ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. │

│Пол ._. (м/ж) │

│Дата рождения "._._." ._._._._._._._._. ._._._._. года │

│Место рождения: │

│ город (село, деревня, ...) ._._._._._._._._._._._._._._._._._._._._._. │

│ район ._._._._._._._._._._._._._._._._._._._._._. │

│ область (край, республика, ...) ._._._._._._._._._._._._._._._._._._._._._. │

│ 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 │

│Вид документа ._._._._._._._._._._._._._._._._._._._._._._._._._. │

│ (указать вид документа, удостоверяющего личность, в соответствии с│

│ законодательством Российской Федерации) │

│Серия, номер ._._._._._._._._._._._._._._._._._._._. │

│Дата выдачи "._._." ._._._._._._._._. ._._._._. года │

│Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._. │

│ ._._._._._._._._._._._._._._._._._._._._._._._._._. │

│Номер актовой записи при рождении ._._._._._._._._._._._._._._._._._._._._._._._._._. │

│(заполняется при предъявлении свидетельства о рождении) │

│ │

│Идентификационный номер налогоплательщика (при наличии) ._._._._._._._._._._._._._._._. │

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Дата заполнения Подпись зарегистрированного лица

(представителя)

"._._." ._._._._._._._._. ._._._._. года ________________________________