Приложение 2. Заявление об изменении анкетных данных зарегистрированного лица, содержащихся в индивидуальном лицевом счете (Форма АДВ-2)

Приложение 2

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-2

Код по ОКУД

Заявление об изменении анкетных данных зарегистрированного лица,

содержащихся в индивидуальном лицевом счете

Заполняется печатными буквами

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

│Страховой номер ._._._. - ._._._. - ._._._. ._._. │

│Ф.И.О., указанные в документе, подтверждающем регистрацию в системе индивидуального│

│(персонифицированного) учета │

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

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

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

│Новые анкетные данные (указать только изменившиеся данные) │

│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 ________________________________