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The document ceased to be valid since June 12, 2016 according to the Order of the Ministry of Labour and Social Protection of the Russian Federation of May 4, 2016 No. 213n

It is registered

Ministry of Justice

Russian Federation

On December 15, 2009 No. 15607

ORDER OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION

of October 26, 2009 No. 847n

About approval of report form (calculation) represented by persons who voluntarily entered legal relationship on compulsory social insurance on case of temporary disability and in connection with motherhood, procedure and terms of its representation

According to part 3 of article 4.8 of the Federal Law of December 29, 2006 N 255-FZ "About compulsory social insurance on case of temporary disability and in connection with motherhood" (The Russian Federation Code, 2007, N 1, Art. 18; 2009, N 30, 3739) I order to the Art.:

1. Approve:

report form (calculation) represented by persons who voluntarily entered legal relationship on compulsory social insurance on case of temporary disability and in connection with motherhood (the Form-4a of Social Insurance Fund of the Russian Federation) according to the appendix N 1;

procedure and terms of submission of the report (calculation) by persons who voluntarily entered legal relationship on compulsory social insurance on case of temporary disability and in connection with motherhood (the Form-4a of Social Insurance Fund of the Russian Federation) according to the appendix N 2.

2. Determine that this order becomes effective since January 1, 2010, since submission of the report (calculation) by persons who voluntarily entered legal relationship on compulsory social insurance on case of temporary disability and in connection with motherhood for 2010.

Minister

T. Golikova

Appendix No. 1

to the Order of the Ministry of Health and Social Development of the Russian Federation of October 26, 2009 No. 847n

Form-4a of Social Insurance Fund of the Russian Federation

  It is constituted and is represented
    annually, no later than January 15 of year,
    following after accounting year, in
    territorial authority Fonda
    social insurance Russian
    Federations in place of registration

                                      +-------------------+
Регистрационный номер страхователя | | | | | | | | | | |
|-+-+-+-+-+---------+
Код подчиненности | | | | | |
|-+-+-+-+-+-------------+
ИНН | | | | | | | | | | | | |
|-+-+-+-+-+-+-+-+-+-+-+-+-----+
ОГРНИП | | | | | | | | | | | | | | | |
+-----------------------------+
                            ОТЧЕТ (РАСЧЕТ)
ПРЕДСТАВЛЯЕМЫЙ ЛИЦАМИ, ДОБРОВОЛЬНО ВСТУПИВШИМИ В ПРАВООТНОШЕНИЯ ПО
ОБЯЗАТЕЛЬНОМУ СОЦИАЛЬНОМУ СТРАХОВАНИЮ НА СЛУЧАЙ ВРЕМЕННОЙ
НЕТРУДОСПОСОБНОСТИ И В СВЯЗИ С МАТЕРИНСТВОМ
                         за     20_______ год
     _________________________________________________________________
(Фамилия, имя, отчество физического лица)
     Место жительства ________________________________________________
Дата представления отчета (расчета) _____________________________
______________________________________________________________________
     Принято: ________________________________________________________
(заполняется работником территориального органа Фонда
социального страхования Российской Федерации)
Дата принятия __________________________________
______________________________ ______________________________
(Ф.И.О.) (подпись)
Место для штампа
                 СВЕДЕНИЯ ОБ УПЛАТЕ СТРАХОВЫХ ВЗНОСОВ
                                                             Таблица 1
+--------------------------------------------------------------------+
| Стоимость | Код | Перечислено** |
|страхового года |строк |--------------------------------------------|
| (сумма)* | | Платежный документ |номер | дата | сумма|
|----------------+------+-----------------------+------+------+------|
| 1 | 2 | 3 | 4 | 5 | 6 |
|----------------+------+-----------------------+------+------+------|
| | 1 | | | | |
| |------+-----------------------+------+------+------|
| | 2 | | | | |
| |------+-----------------------+------+------+------|
| | 3 | | | | |
| |------+-----------------------+------+------+------|
| | 4 | | | | |
| |------+-----------------------+------+------+------|
| | 5 | | | | |
| |------+-----------------------+------+------+------|
| | 6 | | | | |
| |------+-----------------------+------+------+------|
| | 7 | | | | |
| |------+-----------------------+------+------+------|
| | 8 | | | | |
| |------+-----------------------+------+------+------|
| | 9 | | | | |
| |------+-----------------------+------+------+------|
| | 10 | | | | |
| |------+-----------------------+------+------+------|
| | 11 | | | | |
| |------+-----------------------+------+------+------|
| | 12 | | | | |
|----------------+------+-----------------------+------+------+------|
|ИТОГО (стр. | 13 | X | X | X | |
|1-12) | | | | | |
+--------------------------------------------------------------------+
     _____________________________
* Страховые взносы в размере стоимости страхового года подлежат
уплате в Фонд социального страхован

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