Ðåºñòðàö³éíà çàÿâà ïëàòíèêà ïîäàòêó

Ìîâà çà- Óêðà¿íñüêà ijÿ Ðåºñòðàö³ÿ Çì³íè Äîïîâíåííÿ

ïîâíåííÿ ˜ ˜ ˜ ˜

1. ²äåíòèô³êàö³éíèé êîä ïëàòíèêà ïîäàòêó ç ªÄÐÏÎÓ _______________________________________

²äåíòèô³êàö³éíèé êîä Ãîëîâíîãî ï³äïðèºìñòâà ç ªÄÐÏÎÓ ___________________________________

2. Íàçâà ____________________________________________________________________________

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3. Íàçâà ïîäàòêîâîãî îðãàíó, äå ðåºñòðóºòüñÿ ïëàòíèê ______________________________________

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4. Äàí³ ïðî äåðæàâíó ðåºñòðàö³þ

Êîä òà íàçâà îðãàíó äåðæàâíî¿ ðåºñòðàö³¿ _______________________________________________

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Äàòà ðåºñòðàö³¿ ___________________ Íîìåð ð³øåííÿ ïðî ðåºñòðàö³þ ______________________

Êîä òà íàçâà ôîðìè âëàñíîñò³ _________________________________________________________

Îðãàí³çàö³éíî-ïðàâîâà ôîðìà _________________________________________________________

Îçíàêà íåïðèáóòêîâî¿ îðãàí³çàö³¿ (óñòàíîâè) òà äàòà ¿¿ ïðèñâîºííÿ ___________________________

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Âèäè ãîñïîäàðñüêî¿ Êîä îñíîâíîãî Îçíàêà çîâí³øíüîåêîíî-

ä³ÿëüíîñò³ âèäó ì³÷íî¿ ä³ÿëüíîñò³

Çîâí³- Çîâí³- Çîâí³-

øíüî- øíüî- øíüî-

åêîíî- åêîíî- åêîíî-

ì³÷íà ì³÷íà ì³÷íà

Íåîñíîâí³ ä³ÿëü- ä³ÿëü- ä³ÿëü-

Êîä í³ñòü Êîä í³ñòü Êîä í³ñòü

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Êîä òà íàçâà îðãàíó óïðàâë³ííÿ ______________________________________________________

Íàçâà â³äîìñòâà ó ñêëàä³ îðã.óïðàâë³ííÿ _______________________________________________

Êîä ôîðìè ô³íàíñóâàííÿ (áþäæåò — 1, ãîñïðîçðàõóíîê — 2, çà ðàõóíîê ÷ëåíñüêèõ âíåñê³â — 3, çì³øàíå — 9) ˜

Ñòàòóòíèé ôîíä (ó ãðí) ______________________________________________________________

ʳëüê³ñòü ïðàöþþ÷èõ çã³äíî ç³ øòàòíèì ðîçêëàäîì íà ìîìåíò ðåºñòðàö³¿ _____________________

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5. Äàí³ ïðî áàíê³âñüê³ ðàõóíêè

ÌÔÎ áàíêó Ðàõóíîê ¹

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6. Àäðåñí³ äàí³ ïëàòíèêà ïîäàòêó (ì³ñöåçíàõîäæåííÿ)

Ïîøòîâèé ³íäåêñ ______________ Êðà¿íà ___________________________________________

Îáëàñòü ___________________________________________________________________________

Ðàéîí _____________________________________________________________________________

̳ñòî ______________________________________________________________________________

Ðàéîí ì³ñòà _________________________________________________________________________

Âóëèöÿ _____________________________________________________________________________

Áóäèíîê _____________________ Êîðïóñ __________________ Îô³ñ/êâàðòèðà _________________

7. Äàí³ ïðî êåð³âíèê³â

Êåð³âíèê (³äåíòèô³êàö³éíèé íîìåð ³ç Äåðæàâíîãî ðåºñòðó, ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³) __________

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Êîíòàêòí³ òåëåôîíè _______________________ Ôàêñ __________________ Ôàêñ ________________

Ãîëîâíèé áóõãàëòåð (³äåíòèô³êàö³éíèé êîä ³ç Äåðæàâíîãî ðåºñòðó, ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³) ___

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Êîíòàêòí³ òåëåôîíè _______________________ Ôàêñ __________________ Ôàêñ _______________

8. Äàí³ ïðî ðåºñòðàö³þ ïëàòíèêà

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ïðàö³âíèêà, ÿêèé ââîäèâ äàí³ ïðî ïëàòíèêà â àâòîìàòèçîâàíó ñèñòåìó

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ϳäïèñ______________________________ Äàòà_______________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ â³äïîâ³äàëüíîãî çà ðåºñòðàö³þ ïëàòíèê³â ïîäàòê³â _________________

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ϳäïèñ_____________________________ Äàòà_______________________________________

Ì. Ï.

9. ²íôîðìàö³ÿ ïðî çàñíîâíèê³â (þðèäè÷íèõ îñ³á)

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà ______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)_______________________ Íàçâà âàëþòè _____________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà ______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)_________________________ Íàçâà âàëþòè ____________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà ______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)__________________________ Íàçâà âàëþòè ___________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà ______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)__________________________ Íàçâà âàëþòè ___________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà ______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)________________________ Íàçâà âàëþòè ____________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — þðèäè÷íî¿ îñîáè ç ªÄÐÏÎÓ _____________________________

Íàçâà _______________________________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)_______________________ Íàçâà âàëþòè _____________________

Ñòîð³íêà ¹ ³äåíòèô³êàö³éíèé êîä ïëàòíèêà ç ªÄÐÏÎÓ ____________________________________________

10. ²íôîðìàö³ÿ ïðî çàñíîâíèê³â (ô³çè÷íèõ îñ³á)

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè ________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ___________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)________________________ Íàçâà âàëþòè _____________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè _________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ____________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)___________________________ Íàçâà âàëþòè __________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè _________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ____________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)______________________ Íàçâà âàëþòè _______________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè _________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ____________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)________________________ Íàçâà âàëþòè _____________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè ________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ___________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)__________________________ Íàçâà âàëþòè ___________________

²äåíòèô³êàö³éíèé êîä çàñíîâíèêà — ô³çè÷íî¿ îñîáè _________________________________________

Ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³ ____________________________________________________________

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Âíåñîê ó ñòàòóòíèé ôîíä (ñóìà)___________________________ Íàçâà âàëþòè __________________

Ñòîð³íêà ¹ ³äåíòèô³êàö³éíèé êîä ïëàòíèêà ç ªÄÐÏÎÓ __________________________________

Ïîèñê ïî ñàéòó: