In

(name of territorial authority of Fund

pension and social insurance

Russian Federation)

Statement

about the introduction in legal relationship on mandatory pension insurance

Voluntarily I enter legal relationship on obligatory

to pension insurance according to the subitem

__________________________________________________________________

(one of subitems 1, of 2, of 3, of 5, of the 6 or 7 Item 1 is specified

article 29 of the Federal Law of December 15, 2001 No. 167-FZ

"About mandatory pension insurance in the Russian Federation")

Item 1 of article 29 of the Federal Law of December 15, 2001.

No. 167-FZ "About mandatory pension insurance in Russian

Federations" also I ask to register me as the insurer.

I. Information about the applicant

Surname, name, middle name (in the presence)

Birth date

Birthplace

(number, month, year)

Insurance number of the individual ledger account of insured person

-

-

-

INN

(in the presence)

Code of IFTS

(at the place of residence of the physical person who voluntarily entered legal relationship)

Nationality

The residential address in the Russian Federation

(postal address)

The country of permanent residence before arrival in the Russian Federation

(for foreign citizens) ________________________________________

Date of expected departure out of limits of the territory Russian

Federations (for foreign citizens) ______________________________

(number, month, year)

The postal address for the direction of the notice of registration

the insurer who voluntarily entered legal relationship on

to mandatory pension insurance:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Contact phone number:

II. The bases for registration as the insurer

The citizen of the Russian Federation working outside the territory of the Russian Federation for the purpose of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation pro se

Physical person, for the purpose of payment of insurance premiums for other physical person for which payment of insurance premiums by the insurer according to the Federal Law of December 15, 2001 No. 167-FZ "About mandatory pension insurance in the Russian Federation" and part two of the Tax Code of the Russian Federation is not performed

The individual entrepreneur performing payment of insurance premiums in the fixed size, in the part exceeding this size

The notary who is engaged in private practice and performing payment of insurance premiums in the fixed size, in the part exceeding this size

The lawyer performing payment of insurance premiums in the fixed size, in the part exceeding this size

The arbitration manager performing payment of insurance premiums in the fixed size, in the part exceeding this size

The other persons who are engaged in private practice and performing payment of insurance premiums in the fixed size, in the part exceeding this size

Physical person for the purpose of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation pro se, constantly or temporarily living in the territory of the Russian Federation on which mandatory pension insurance according to the Federal Law of December 15, 2001 No. 167-FZ "On mandatory pension insurance in the Russian Federation", except for persons specified in subitems 6 and 7 of Item 1 of article 29 of this law does not expatiate

The physical person for the purpose of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation pro se which is applying special tax regime "Tax on the professional income", constantly or temporarily living in the territory of the Russian Federation

Physical person from among individual entrepreneurs, lawyers, arbitration managers, notaries who are engaged in private practice and the other persons who are engaged in private practice and not being individual entrepreneurs, being receivers of long-service pension or disability pension according to the Law of the Russian Federation of February 12, 1993 No. 4468-I "About provision of pensions of persons passing military service, service in law-enforcement bodies, the Public fire service, drug trafficking monitoring bodies and psychotropic substances, organizations and bodies of criminal executive system, troops of national guard of the Russian Federation, bodies of forced execution of the Russian Federation, and their families" for the purpose of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation pro se

The head of peasant farm performing payment of insurance premiums in the fixed size, in the part exceeding this size

III. Data on the title document

Document type:

the document confirming the work fact outside the territory of the Russian Federation or the document confirming the fact of job invitation out of limits of the territory of the Russian Federation:

;

(name of the document)

other document

(name of the document)

,

(the name of the body which issued the title document)

registration document number

,

registration date of the document

,

(number, month, year)

expiry date of the document

,

(the number, month, year or "is termless")

date of execution of an employment agreement (contract) for work

outside the territory of the Russian Federation ____________________,

(number, month, year)

expiry date of the employment contract (contract)

for work outside the territory of the Russian Federation

_______________________;

(number, month, year)

the data (information) confirming the fact of registration

in tax authority as the taxpayer applying

special tax regime "Tax on the professional income"

(received by means of the My Tax mobile application,

used according to the Federal Law of November 27

2018 No. 422-FZ "About carrying out experiment on establishment

special tax regime "Tax on professional

income"):

________________________________________________________________,

date of registration in tax authority

as the taxpayer applying

special tax regime

"Tax on the professional income" _______________________________;

(number, month, year)

the data (information) confirming the fact of registration

in tax authority of physical person as individual

entrepreneur, lawyer, arbitration manager, notary,

engaged in private practice, and the other person who is engaged

private practice and not being individual

the entrepreneur (received by territorial authority of Fund

pension and social insurance of the Russian Federation

from tax authorities):

________________________________________________________________,

date of registration in tax authority

as the individual entrepreneur,

lawyer, arbitration manager,

the notary who is engaged in private

practice, and the other person who is engaged

private practice and not being

individual entrepreneur _________________________________;

(number, month, year)

the data (information) confirming the fact of receipt of long-service pension or disability pension according to the Law of the Russian Federation of February 12, 1993 No. 4468-I "About provision of pensions of persons passing military service, the service in law-enforcement bodies, the Public fire service, drug trafficking monitoring bodies and psychotropic substances, organizations and bodies of criminal executive system, troops of national guard of the Russian Federation, bodies of forced execution of the Russian Federation, and their families" (provided by physical person or received by territorial authority of Fund of pension and social insurance of the Russian Federation in the bodies performing pension payment for long service or disability pensions):

,

date of establishment of pension

(number, month, year)

IV. The information about the physical person for which payment of insurance premiums is performed

(surname, name, middle name (in the presence)

Residential address

(postal address)

Identity document

:

(document type)

series

number

date of issue "__" ______________________.

whom and when it is issued

Insurance number of the individual ledger account of insured person

-

-

-

V. Data on payment of insurance premiums

The size of insurance premiums and procedure for their payment are determined according to article 29 of the Federal Law of December 15, 2001 No. 167-FZ "About mandatory pension insurance in the Russian Federation".

I confirm reliability and completeness of the data specified in this statement.

Signature of the applicant

Date

(number, month, year)

VI. Data on registration of insurer

Registration room in Fund of pension and social insurance of the Russian Federation

Date of registration

(number, month, year)

Issued the notification

(position)

(signature)

(surname, name, middle name (in the presence)

Received the notification

(signature)

(surname, name, middle name (in the presence)

(date)

The notification is directed with use of services of mail service

(position)

(signature)

(surname, name, middle name (in the presence)

(date)

Code of category of the insurer

In

(name of territorial authority of Fund

pension and social insurance

Russian Federation)

Statement

about the termination of legal relationship on mandatory pension insurance

I stop legal relationship on mandatory pension insurance according to Item 3 of article 29 of the Federal Law of December 15, 2001 No. 167-FZ "About mandatory pension insurance in the Russian Federation" and I ask to strike me off the registration register as the insurer.

I. Information about the applicant

Surname, name, middle name (in the presence)

Birth date

Birthplace

(number, month, year)

Insurance number of the individual ledger account of insured person

-

-

-

INN

(in the presence)

Code of IFTS

(at the place of residence of the physical person who voluntarily entered legal relationship)

The postal address for the direction of the withdrawal notice from registration accounting of the insurer who stopped legal relationship on mandatory pension insurance __________________________________________________________________________

_________________________________________________________________________

Contact phone number:

II. The bases for removal from accounting as the insurer

Due to the termination of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation by the citizen of the Russian Federation working outside the territory of the Russian Federation

Due to the termination of payment of insurance premiums in Fund of pension and social insurance of the Russian Federation for other physical person for which payment according to the Federal Law of December 15, 2001 No. 167-FZ "About mandatory pension insurance in the Russian Federation" and part two of the Tax Code of the Russian Federation is not performed

Due to the termination by the individual entrepreneur of payment of insurance premiums in the fixed size in the part exceeding this size

Due to the termination by the notary of payment of insurance premiums in the fixed size in the part exceeding this size

Due to the termination by the lawyer of payment of insurance premiums in the fixed size in the part exceeding this size

Due to the termination by the arbitration manager of payment of insurance premiums in the fixed size in the part exceeding this size

Due to the termination by the head of peasant farm of payment of insurance premiums in the fixed size in the part exceeding this size

Due to the termination of the other persons who are engaged in private practice, payments of insurance premiums in the fixed size in the part exceeding this size

Due to the termination of payment of insurance premiums pro se physical person, constantly or temporarily living in the territory of the Russian Federation on whom mandatory pension insurance according to the Federal Law of December 15, 2001 No. 167-FZ "On mandatory pension insurance in the Russian Federation", except for persons specified in subitems 6 and 7 of Item 1 of article 29 of this law does not expatiate

Due to the termination of the payment of insurance premiums by physical person pro se which is applying special tax regime "Tax on the professional income", constantly or temporarily living in the territory of the Russian Federation

Due to the change of registration at the place of residence

Due to the termination of payment of insurance premiums pro se physical person from among individual entrepreneurs, lawyers, arbitration managers, notaries who are engaged in private practice and the other persons who are engaged in private practice and not being individual entrepreneurs, being receivers of long-service pension or disability pension according to the Law of the Russian Federation of February 12, 1993 No. 4468-1 "About provision of pensions of persons passing military service, service in law-enforcement bodies, the Public fire service, drug trafficking monitoring bodies and psychotropic substances, organizations and bodies of criminal executive system, troops of national guard of the Russian Federation, bodies of forced execution of the Russian Federation, and their families"

III. The information about the physical person for which payment of insurance premiums was performed

(surname, name, middle name (in the presence)

Insurance number

individual personal account

insured person

-

-

-

I confirm reliability and completeness of the data specified in this statement.

Signature of the applicant

Date

(number, month, year)

IV. Mark about removal from accounting of the insurer

Registration room in Fund of pension and social insurance of the Russian Federation

Date of removal from accounting

(number, month, year)

Issued the notification

(position)

(signature)

(surname, name, middle name (in the presence)

Received the notification

(signature)

(surname, name, middle name (in the presence)

(date)

The notification is directed with use of services of mail service

(position)

(signature)

(surname, name, middle name (in the presence)

(date)

Notification

about registration in territorial authority of Fund of pension and social insurance of the Russian Federation the insurer who voluntarily entered legal relationship on mandatory pension insurance

Dear

,

(surname, name, middle name (in the presence)

living to the address

(postal address)

,

we report that based on your statement in compliance

with the legislation of the Russian Federation on obligatory

pension insurance you are registered _______________________

(number, month, year)

as the insurer in ________________________________________

__________________________________________________________________

(name of territorial authority of the pension fund

and social insurance of the Russian Federation)

in the place of your residence.

INN (in the presence)

With assignment of registration number

Authorized person of territorial authority of Fund of pension and social insurance of the Russian Federation

(signature)

(surname, name, middle name (in the presence)

M.P.

".