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

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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 постоянного индекс ._._._._._._. адрес ._._._._._._._._._._._._._._. │

│места жительства ._._._._._._._._._._._._._._._._._._._._._._._._. │

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

│Адрес места индекс ._._._._._._._. адрес ._._._._._._._._._._._._._. │

│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) │

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

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

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

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

│Реквизиты акта гражданского состояния о рождении: │

│Номер актовой записи о рождении ._._._._._._._._._._._._._._._._._._._._._._._._._. │

│Дата составления актовой записи о рождении "._._." ._._._._._._._._. ._._._._. года │

│Наименование органа, которым произведена государственная регистрация акта о рождении ._._._._._._._._._.│

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

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

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