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The document ceased to be valid since August 16, 2016 according to Item 2 of the Order of the Federal Tax Service of the Russian Federation of  July 13, 2016 No. MMB-7-11/403 @

It is registered

in Ministry of Justice

Russian Federation

On December 4, 2007 No. 10620

ORDER OF THE FEDERAL TAX SERVICE

of November 12, 2007 No. MM-3-04/625 @

About the Reference form

It is approved

Ministry of Finance

Russian Federation

 

According to Item 1.1 of article 213 of the Tax Code of the Russian Federation (The Russian Federation Code, 2000, N 32, 3340, of 2007, N 31, of the Art. 4013) I order to the Art.:

1. Approve form of the Certificate of confirmation of non receipt by the taxpayer of social tax deduction or confirmation of the fact of obtaining by the taxpayer of the amount of the provided social tax deduction specified in the subitem 4 of Item 1 of article 219 of the Tax Code of the Russian Federation according to appendix to this order.

2. To Offices of the Federal Tax Service in subjects of the Russian Federation to bring this order to subordinate tax authorities and to provide its accomplishment.

3. To impose control of execution of this order on the deputy manager of the Federal Tax Service I. F. Golikov.

 

Head

Federal Tax Service M. P. Mokretsov

Approved by the order of the Federal Tax Service of November 12, 2007 No. MM-3-04/625 @

 
                          Форма КНД 1160077

"__" ________ 20__ г. N ______________

The certificate of confirmation of non receipt by the taxpayer of social tax deduction or confirmation of the fact of obtaining by the taxpayer of the amount of the provided social tax deduction specified in the subitem 4 of Item 1 of article 219 of the Tax Code of the Russian Federation for ______________ year

 
 Инспекция ФНС России__________________________________________________
(наименование
______________________________________________________________________
инспекции, код инспекции)
в соответствии с подпунктом 4 пункта 1 статьи 213 и пунктом 2 статьи
213.1 Налогового кодекса Российской Федерации, подтверждает факт _____
_______________________________________________ (1) налогоплательщиком
______________________________________________________________________
(фамилия, имя, отчество, ИНН (при наличии))
______________________________________________________________________
(данные документа, удостоверяющего личность,
______________________________________________________________________
место жительства)
социального налогового вычета, указанного в подпункте 4 пункта 1
статьи 219 Налогового кодекса Российской Федерации, в части уплаченных
им взносов по договору _______________________________________________
(вид договора)
(2) от___________ N ______________, заключенному с____________________
(дата) (номер)
______________________________________________________________________
(ИНН/КПП, наименование организации)
в сумме (3)___________________________________________________________
(цифрами и прописью)
______________________________________________________________________

Справка выдана налогоплательщику______________________________________
______________________________________________________________________
(ИНН (при наличии), фамилия, имя, отчество)
для представления налоговому агенту___________________________________
______________________________________________________________________
(ИНН, КПП организации, наименование организации)

Начальник (Заместитель начальника)
инспекции ФНС России ______________________ (________________________)
(подпись) (фамилия, имя, отчество)
М.П.
     ______________________________
(1) указать факт "неполучения" или "получения";
(2) указать вид договора "добровольного пенсионного страхования"
или "негосударственного пенсионного обеспечения";
(3) заполняется в случае получения социального налогового вычета.

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