Приложение № 2
к приказу Фонда пенсионного
и социального страхования
Российской Федерации
от 17 ноября 2025 г. № 1461
Форма АДВ-2
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Код по ОКУД | |+--------+
Заявление об изменении анкетных данных зарегистрированного лица, содержащихся в индивидуальном лицевом счетеЗаполняется зарегистрированным лицом печатными буквами
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|Страховой номер индивидуального лицевого счета ._._._.- ._._._.-._._._. ._._. |
|Данные, 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 "._._." ._._._._._._._._. ._._._._.г. |
|Место рождения: |
| населенный пункт ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| район ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| регион (область, край, |
| республика,...) ._._._._._._._._._._._._._._._._._._._._. |
| страна ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Гражданство ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Адрес индекс ._._._._._. адрес ._._._._._._._._._._._._._._._._. . |
|постоянного ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|места жительства ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Адрес индекс ._._._._._._. адрес ._._._._._._._._._._._._._._._._._. |
|места ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|пребывания ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| (заполнять при отличии от адреса постоянного места жительства) |
|Телефон ._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| (городской и/или мобильный) |
| |
|Документ, удостоверяющий личность |
|Вид документа ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| (указать название документа: паспорт, удостоверение личности или другие документы, |
| удостоверяющие личность) |
| |
|Серия, номер ._._._._._._._._._._._._._._._._._._. |
| |
|Дата выдачи "._._." ._._._._._._._._. ._._._._.г. |
| |
|Кем выдан ._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
| |
|Реквизиты акта гражданского состояния о рождении: |
|Номер актовой записи о рождении ._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Дата составления актовой записи о рождении "._._." ._._._._._._._._. ._._._._.г. |
|Наименование органа, которым произведена государственная регистрация акта о рождении ._._._._._._. |
|._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._. |
|Идентификационный номер налогоплательщика (при наличии) ._._._._._._._._._._._._. |
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Дата заполнения Подпись зарегистрированного лица (представителя)
"._._." ._._._._._._._._. ._._._._.г. _________________________________________________