Приложение 1 Утверждены
постановлением Правления
Пенсионного фонда
Российской Федерации
от 1 июня 2016 г. N 473п ФОРМЫ ДОКУМЕНТОВ
ИНДИВИДУАЛЬНОГО (ПЕРСОНИФИЦИРОВАННОГО) УЧЕТА В СИСТЕМЕ
ОБЯЗАТЕЛЬНОГО ПЕНСИОННОГО СТРАХОВАНИЯ
Анкета застрахованного лица Заполняется застрахованным лицом печатными буквами. ┌─────────────────────────────────────────────────────────────────────────┐
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Пол ._. (м/ж) │
│Дата рождения "._._." ._._._._._._._._._ ._._._._. года │
│Место рождения: │
│ 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 │
│Вид документа ._._._._._._._._._._._._._._._._._._._._._._. │
│ (указать название документа: паспорт, удостоверение │
│ личности и другие документы, удостоверяющие личность) │
│Серия, номер ._._._._._._._._._._._._._._._._._._._. │
│Дата выдачи "._._." ._._._._._._._._. ._._._._. года │
│Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ ._._._._._._._._._._._._._._._._._._._._._._._._._. │
└─────────────────────────────────────────────────────────────────────────┘ Дата заполнения Личная подпись
"._._." ._._._._._._._._. ._._._._. года застрахованного лица _______
Форма АДИ-1 Страховое свидетельство Лицевая сторона Российская Федерация СТРАХОВОЕ СВИДЕТЕЛЬСТВО
ГОСУДАРСТВЕННОГО ПЕНСИОННОГО СТРАХОВАНИЯ <страховой номер>
Ф.И.О.
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Оборотная сторона Страховое свидетельство хранится у застрахованного лица.
Страховое свидетельство действительно только при предъявлении паспорта
или иного документа, удостоверяющего личность.
Застрахованное лицо предъявляет страховое свидетельство при приеме на
работу по трудовому договору, при заключении договора гражданско-правового
характера, предметом которого является выполнение работ и оказание услуг,
или авторского договора.
Страховое свидетельство подлежит обмену в случаях:
изменения фамилии, имени, отчества, даты рождения, места рождения или
пола застрахованного лица;
установления неточности или ошибочности содержащихся в нем сведений;
непригодности для использования.
Форма АДИ-7 Страховое свидетельство Лицевая сторона Российская Федерация СТРАХОВОЕ СВИДЕТЕЛЬСТВО
ОБЯЗАТЕЛЬНОГО ПЕНСИОННОГО СТРАХОВАНИЯ <страховой номер>
Ф.И.О.
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| <
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| Дата регистрации
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Оборотная сторона Страховое свидетельство хранится у застрахованного лица.
Страховое свидетельство действительно только при предъявлении паспорта
или иного документа, удостоверяющего личность.
Застрахованное лицо предъявляет страховое свидетельство при приеме на
работу по трудовому договору, при заключении договора гражданско-правового
характера, предметом которого является выполнение работ и оказание услуг,
или авторского договора.
Страховое свидетельство подлежит обмену в случаях:
изменения анкетных данных, указанных на лицевой стороне страхового
свидетельства;
установления неточности или ошибочности содержащихся в нем сведений;
непригодности для использования.
Заявление об обмене страхового свидетельства Заполняется застрахованным лицом печатными буквами. ┌─────────────────────────────────────────────────────────────────────────┐
│Страховой номер ._._._. - ._._._. - ._._._. ._._. │
│Ф.И.О., указанные в страховом свидетельстве │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Новые анкетные данные (указать только изменившиеся данные) │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Пол ._. (м/ж) │
│Дата рождения "._._." ._._._._._._._._._ ._._._._. года │
│Место рождения: │
│ 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 │
│Вид документа ._._._._._._._._._._._._._._._._._._._._._._. │
│ (указать название документа: паспорт, удостоверение │
│ личности и другие документы, удостоверяющие личность) │
│Серия, номер ._._._._._._._._._._._._._._._._._._._. │
│Дата выдачи "._._." ._._._._._._._._. ._._._._. года │
│Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ ._._._._._._._._._._._._._._._._._._._._._._._._._. │
└─────────────────────────────────────────────────────────────────────────┘ Дата заполнения Личная подпись
"._._." ._._._._._._._._. ._._._._. года застрахованного лица ___________
Заявление о выдаче дубликата страхового свидетельства Заполняется застрахованным лицом печатными буквами: ┌─────────────────────────────────────────────────────────────────────────┐
│Данные, указанные в страховом свидетельстве │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Пол ._. (м/ж) │
│Дата рождения "._._." ._._._._._._._._._ ._._._._. года │
│Место рождения: │
│ город (село, дер., ...) ._._._._._._._._._._._._._._._._._._._._. │
│ район ._._._._._._._._._._._._._._._._._._._._. │
│ область (край, респ., ...) ._._._._._._._._._._._._._._._._._._._._. │
│ страна ._._._._._._._._._._._._._._._._._._._._. │
│Данные, действительные в настоящее время (указать только изменившиеся │
│данные) │
│Фамилия ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Имя ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Отчество ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│Пол ._. (м/ж) │
│Дата рождения "._._." ._._._._._._._._._ ._._._._. года │
│Место рождения: │
│ 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 │
│Вид документа ._._._._._._._._._._._._._._._._._._._._._._. │
│ (указать название документа: паспорт, удостоверение │
│ личности и другие документы, удостоверяющие личность) │
│Серия, номер ._._._._._._._._._._._._._ ._._._._._._. │
│Дата выдачи "._._." ._._._._._._._._. ._._._._. года │
│Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._. │
│ ._._._._._._._._._._._._._._._._._._._._._._._._._. │
└─────────────────────────────────────────────────────────────────────────┘ Дата заполнения Личная подпись
"._._." ._._._._._._._._. ._._._._. года застрахованного лица ___________ Заполняется страхователем (работодателем). ┌─────────────────────────────────────────────────────────────────────────┐
│Заверяю, что застрахованное лицо имело страховое свидетельство │
│обязательного пенсионного страхования со страховым номером │
│._._._. - ._._._. - ._._._. ._._., на основании которого сведения о его │
│стаже и заработке представлялись/будут представлены в ПФР. │
│-------------------------------------------------- │
│ (ненужное зачеркнуть) │
│ │
│Наименование должности руководителя Подпись Расшифровка подписи│
│ │
│Дата │
└─────────────────────────────────────────────────────────────────────────┘
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