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

Приложение 1

к постановлению Правления

Пенсионного фонда

Российской Федерации

от 27 сентября 2019 г. N 485п

Список изменяющих документов

(в ред. Постановления Правления ПФ РФ от 07.12.2020 N 846п)

(см. текст в предыдущей редакции)

См. данную форму в MS-Excel.

Форма АДВ-1

Код по ОКУД

Анкета зарегистрированного лица

Заполняется печатными буквами

┌────────────────────────────────────────────────────────────────────────────────────────────┐

│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) ._._._._._._._._._._._._._._._. │

└────────────────────────────────────────────────────────────────────────────────────────────┘

Дата заполнения Подпись зарегистрированного лица

(представителя)

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