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It is registered

Ministry of Justice

Russian Federation

On August 20, 2008 No. 12151

RESOLUTION OF BOARD OF THE PENSION FUND OF THE RUSSIAN FEDERATION

of July 28, 2008 No. 225p

About approval of the application form about the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension, the Instruction for its filling, and also format of submission to territorial authority of the Pension Fund of the Russian Federation of the statement for the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension in electronic form (format of data)

(as amended of the Resolution of the Pension Fund of the Russian Federation of 09.06.2016 No. 481p)

It is approved

Ministry of Health

and social development

Russian Federation

 

According to parts 3 and 4 of article 4 of the Federal Law of April 30, 2008 N56-FZ "About Additional Insurance Premiums for Funded Pension and the State Support of Forming of Pension Accruals" (The Russian Federation Code, 2008, N 18, the Art. 1943) the Board of the Pension Fund of the Russian Federation decides:

1. Approve:

the DSV-1 form "The statement for the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension" (appendix 1);

The instruction for filling of the statement for the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension (appendix 2);

format of submission to territorial authority of the Pension Fund of the Russian Federation of the statement for the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension in electronic form (format of data) (appendix 3).

2. This resolution becomes effective since October 1, 2008.

First Deputy Chairman

A.Kurtin

Appendix 1

Approved by the Resolution of Board of the Pension Fund of the Russian Federation

                   DSV-1 _______________________________________ form
                                  (name of territorial authority
                                 Pension Fund of the Russian Federation)

The statement for the voluntary introduction in legal relationship on mandatory pension insurance for the purpose of payment of additional insurance premiums for funded pension


I, ______________________________________________________________________
                                  surname
_________________________________________________________________________
                                    name
_________________________________________________________________________
                                  middle name


+--+--+--+  +--+--+--+  +--+--+--+  +--+--+
¦ ¦ ¦ ¦ - ¦ ¦ ¦ ¦ - ¦ ¦ ¦ ¦  ¦ ¦ ¦
+--+--+--+  +--+--+--+  +--+--+--+  +--+--+
Insurance number of the individual ledger account


Residential address: _________________________________________________
   (postal index, republic, edge, area, settlement, street,
_________________________________________________________________________
house number, case, number of the apartment)
    according to the subitem 4 of Item 1 of article 29 of the Federal Law
"About      mandatory pension insurance in the Russian Federation" *
voluntarily  I enter   legal relationship on obligatory pension
to insurance    for the purpose of  payment  of additional insurance premiums on
funded pension.


+--+--+             +--+--+--+--+
¦ ¦ ¦             ¦ ¦ ¦ ¦ ¦
+--+--+--------------+--+--+--+--+              ________________________
    Date of filling of the statement                            Signature

It is filled:
- notary,
- official of consular establishment of the Russian Federation;
- the employee of body (organization) with whom at the Pension Fund of the Russian Federation the agreement on mutual signature witnessing is signed

Certifying text

It is filled with the employee of territorial authority of the Pension Fund of the Russian Federation

The statement is registered in the magazine of registration of statements "__" ___________ ____ of N _______
__________________________________________
(position and the signature of the employee of territorial authority of the Pension Fund of the Russian Federation which registered the statement)

______________________________

* Russian Federation Code, 2001, No. 51, Art. 4832; 2002, No. 22, Art. 2026; 2003, No. 1, Art. 13; No. 52, Art. 5037; 2004, No. 57, Art. 2711; No. 30, Art. 3088; No. 49, Art. 4854; Art. 4856; 2005, No. 1, Art. 9; No. 45, Art. 4585; 2006, No. 6, Art. 636; No. 31, Art. 3436; 2007, No. 30, Art. 3754; 2008, No. 18, Art. 1942

 

Appendix 2

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