Лютий І. О. Податкова система України
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431
ȼɿɞɦɿɬɤɚ ɩɪɨ ɨɞɟɪɠɚɧɧɹ (ɲɬɚɦɩ Ⱦɉȱ)
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ
ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 25 ɱɟɪɜɧɹ 2003 ɪ. N 311
ɊɈɁɊȺɏɍɇɈɄ ɊȿɇɌɇɈȲ ɉɅȺɌɂ ɁȺ ɌɊȺɇɁɂɌɇȿ ɌɊȺɇɋɉɈɊɌɍȼȺɇɇə ɉɊɂɊɈȾɇɈȽɈ ȽȺɁɍ
ɌȿɊɂɌɈɊȱȯɘ ɍɄɊȺȲɇɂ
Ɂɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
1
ɍɬɨɱɧɸɸɱɢɣ ɪɨɡɪɚɯɭɧɨɤ
2 Ɂɜɿɬɧɢɣ ɩɟɪɿɨɞ (ɦɿɫɹɰɶ) 2 0 0 ɪɨɤɭ
ʿ̨̡̛̦̦̪̣̯̦̏̌̌̏̌̌̌̚:
3 ɘɪɢɞɢɱɧɚ ɨɫɨɛɚ
4
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ
Ʉɨɞ ɜɢɞɭ ɟɤɨɧɨɦɿɱɧɨʀ ɞɿɹɥɶɧɨɫɬɿ (ɄȼȿȾ)
ƒ
ƒ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ: ɉɨɲɬɨɜɢɣ ɿɧɞɟɤɫ
Ɍɟɥɟɮɨɧ
Ɏɚɤɫ
5
ȿ-mail
Ⱦɨ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ (ɚɞɦɿɧɿɫɬɪɚɰɿʀ) ɜ
6
432
Ɉɞɢɧɢɰɹ ɜɢɦɿɪɭ: ɝɪɢɜɧɹ
N ɡ/ɩ Ⱦɟɤɚɞɚ Ɉɛɫɹɝ ɬɪɚɧɡɢɬɭ, ɬɢɫ.
ɤɭɛ. ɦɟɬɪɿɜ
ȼɿɞɫɬɚɧɶ
ɬɪɚɧɫɩɨɪɬɭɜɚɧɧɹ,
ɤɿɥɨɦɟɬɪɿɜ
ɋɬɚɜɤɚ ɩɥɚɬɟɠɭ ɜ
ɝɪɢɜɧɹɯ ɧɚ
ɨɞɢɧɢɰɸ ɜɢɦɿɪɭ
ɋɭɦɚ ɩɥɚɬɢ,
(ɝɪ. 3 ɯ ɝɪ. 4 ɯ ɝɪ. 5) / 100,
ɝɪɢɜɟɧɶ
1 2 3 4 5 6
1. ɇɚɪɚɯɨɜɚɧɨ ɩɥɚɬɢ ɡɚ ɡɜɿɬɧɢɣ ɦɿɫɹɰɶ, ɭɫɶɨɝɨ (ɫɭɦɚ ɪɹɞɤɿɜ: ɪ. 1.1 + ɪ. 1.2 + ɪ. 1.3 ɝɪ. 6)
1.1 I
1.2 II
1.3 III
2. ɇɚɪɚɯɨɜɚɧɨ ɩɥɚɬɢ ɡɚ ɞɚɧɢɦɢ ɪɚɧɿɲɟ ɩɨɞɚɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ, ɭɫɶɨɝɨ
(ɪ. 1 ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ)*
3. ɋɭɦɚ ɧɟɞɨɩɥɚɬɢ (ɡɚɧɢɠɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ), ɹɤɚ ɡɛɿɥɶɲɭɽ ɩɨɞɚɬɤɨɜɟ
ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 1 - ɪ. 2)*, ɹɤɳɨ ɪ. 1 > ɪ. 2
4. ɋɭɦɚ ɩɥɚɬɢ, ɹɤɚ ɡɦɟɧɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ
(ɩɨɦɢɥɨɤ) (ɪ. 2 - ɪ. 1)*, ɹɤɳɨ ɪ. 2 > ɪ. 1
5. ɋɭɦɚ ɲɬɪɚɮɭ (ɧɚɪɚɯɨɜɭɽɬɶɫɹ ɩɥɚɬɧɢɤɨɦ ɫɚɦɨɫɬɿɣɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17
Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ
ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" ɜɿɞ 21.12.2000 N 2181-III (ɿɡ ɜɧɟɫɟɧɢɦɢ ɡɦɿɧɚɦɢ ɬɚ
ɞɨɩɨɜɧɟɧɧɹɦɢ)) (ɪ. 3) ɯ 5 %
6. Ɂɦɿɫɬ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ)
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɩɿɞɩɭɧɤɬɭ "ɛ" ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ
ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" ɜɿɞ 21.12.2000 N 2181-III (ɿɡ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ)
ɞɨ ɰɶɨɝɨ ɡɜɿɬɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ ɞɨɞɚɽɬɶɫɹ(ɸɬɶɫɹ) ɭɬɨɱɧɸɸɱɢɣ(ɿ) ɪɨɡɪɚɯɭɧɨɤ(ɤɢ) ɡɚ "___________________" (ɦɢɧɭɥɢɣ(ɿ)
ɩɟɪɿɨɞ(ɢ)).
____________
* Ɂɚɩɨɜɧɸɽɬɶɫɹ ɭ ɪɚɡɿ ɩɨɞɚɧɧɹ ɭɬɨɱɧɸɸɱɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɦɿɫɬɢɬɶ ɜɢɩɪɚɜɥɟɧɿ
ɩɨɤɚɡɧɢɤɢ.
433
ƒ ƒ 2 0 0 ɪɨɤɭ
Ⱦɚɬɚ ɡɚɩɨɜɧɟɧɧɹ ɪɨɡɪɚɯɭɧɤɭ (ɞɞ.ɦɦ.ɪɪɪɪ)
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ) (ɩɿɞɩɢɫ)
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɧɨɦɟɪ
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ
Ɇ. ɉ.
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ) (ɩɿɞɩɢɫ)
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɧɨɦɟɪ
ɐɹ ɱɚɫɬɢɧɚ ɪɨɡɪɚɯɭɧɤɭ ɡɚɩɨɜɧɸɽɬɶɫɹ ɫɥɭɠɛɨɜɢɦɢ ɨɫɨɛɚɦɢ Ⱦɉȱ (ȾɉȺ)
ȼɿɞɦɿɬɤɚ ɩɪɨ ɜɧɟɫɟɧɧɹ ɞɚɧɢɯ ɞɨ ɟɥɟɤɬɪɨɧɧɨʀ ɛɚɡɢ ɩɨɞɚɬɤɨɜɨʀ ɡɜɿɬɧɨɫɬɿ "___" ____________ 200_ ɪɨɤɭ
ɫɥɭɠɛɨɜɚ ɨɫɨɛɚ Ⱦɉȱ (ȾɉȺ) (ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ)
Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɚɦɟɪɚɥɶɧɨʀ ɩɟɪɟɜɿɪɤɢ ɪɨɡɪɚɯɭɧɤɭ (ɩɨɬɪɿɛɧɟ ɩɨɡɧɚɱɢɬɢ):
ɩɨɪɭɲɟɧɶ (ɩɨɦɢɥɨɤ) ɧɟ ɜɢɹɜɥɟɧɨ
ɫɤɥɚɞɟɧɨ ɚɤɬ ɜɿɞ "___" ____________ 200_ ɪɨɤɭ N ______
"___" ____________ 200_ ɪɨɤɭ
ɫɥɭɠɛɨɜɚ ɨɫɨɛɚ Ⱦɉȱ (ȾɉȺ) (ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ)
434
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 17 ɜɟɪɟɫɧɹ 2001 ɪ. N 373
"___" _______________ 200_ ɪ.
ȼɯɿɞɧɢɣ N ________________
Ɋɨɡɪɚɯɭɧɨɤ
ɫɭɦɢ ɩɨɞɚɬɤɭ ɡ ɜɥɚɫɧɢɤɿɜ ɬɪɚɧɫɩɨɪɬɧɢɯ ɡɚɫɨɛɿɜ ɬɚ ɿɧɲɢɯ ɫɚɦɨɯɿɞɧɢɯ ɦɚɲɢɧ ɿ ɦɟɯɚɧɿɡɦɿɜ
ɇɚɡɜɚ ɩɿɞɩɪɢɽɦɫɬɜɚ, ɭɫɬɚɧɨɜɢ, ɨɪɝɚɧɿɡɚɰɿʀ ___________________________ Ɂɚɝɚɥɶɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
_______________________________________________________________ ɍɬɨɱɧɟɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ: ______________________________________________
Ɍɟɥɟɮɨɧ: _______________________________________________________ Ɋɨɡɪɚɯɭɧɨɤ ɧɚ 200_ ɪɿɤ
ɉɨɬɨɱɧɢɣ ɪɚɯɭɧɨɤ: ______________________________________________ Ɋɨɡɪɚɯɭɧɨɤ ɡɚ ɩɪɢɞɛɚɧɿ ɬɪɚɧɫɩɨɪɬɧɿ ɡɚɫɨɛɢ
_______________________________________________________________
(ɧɚɡɜɚ ɛɚɧɤɿɜɫɶɤɨʀ ɭɫɬɚɧɨɜɢ)
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ Ʉɨɞ ɡɚ ɁɄȽɇȽɍ
Ɋɨɡɪɚɯɭɧɨɤ ɩɨɞɚɽɬɶɫɹ ɞɨ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ ɜ*
(ɝɪɧ.)
ɉɿɥɶɝɢ
N
ɡ/ɩ
Ʉɨɞ
ɬɪɚɧɫɩɨɪɬɧɨɝɨ
ɡɚɫɨɛɭ ɡɝɿɞɧɨ
Ƚɚɪɦɨɧɿɡɨɜɚɧɨʀ
ɫɢɫɬɟɦɢ ɨɩɢɫɭ
ɬɚ ɤɨɞɭɜɚɧɧɹ
ɬɨɜɚɪɿɜ
Ɇɚɪɤɚ
ɬɪɚɧɫɩɨɪɬ-
ɧɨɝɨ ɡɚɫɨɛ
ɭ
Ɇɨɞɟɥɶ
ɬɪɚɧɫɩɨɪɬ-
ɧɨɝɨ ɡɚɫɨɛ
ɭ
1) Ɉɛ'ɽɦ ɰɢɥɿɧɞɪɿɜ
ɞɜɢɝɭɧɚ (ɫɦ ɤɭɛ.)
2) ɉɨɬɭɠɧɿɫɬɶ ɞɜɢɝɭɧɚ
(ɤȼɬ)
3) Ⱦɨɜɠɢɧɚ ɤɨɪɩɭɫɭ (ɫɦ)
Ʉɿɥɶɤɿɫɬɶ
ɨɞɧɨɪɿɞɧɢɯ
ɬɪɚɧɫɩɨɪ-
ɬɧɢɯ ɡɚɫɨɛɿɜ
ɋɬɚɜɤɚ ɩɨɞɚɬɤɭ
ɜ ɝɪɧ. ɧɚ ɪɿɤ:
1) ɡɿ 100 ɫɦ ɤɭɛ.
2) ɡ 1 ɤȼɬ
3) ɡɿ 100 ɫɦ
ɋɭɦɚ
ɧɚɪɚɯɨ-
ɜɚɧɨɝɨ
ɩɨɞɚɬɤɭ
Ʉɨɞ
ɡɝɿɞɧɨ ɡ
ɞ
ɨɜɿɞɧɢɤɨɦ
ɩɿɥɶɝ
ɋɭɦɚ
ɋɭɦɚ
ɩɨɞɚɬɤɭ, ɳɨ
ɩɿɞɥɹɝɚɽ
ɫɩɥɚɬɿ
1 2 3 4 5 6 7 8 9 10 11
____________
* ɉɨɞɚɽɬɶɫɹ ɞɨ ɨɪɝɚɧɿɜ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ ɡɚ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹɦ ɩɥɚɬɧɢɤɚ ɩɨɞɚɬɤɭ ɬɚ ɡɚ ɦɿɫɰɟɦ ɩɨɫɬɿɣɧɨɝɨ ɛɚɡɭɜɚɧɧɹ ɬɪɚɧɫɩɨɪɬɧɢɯ ɡɚɫɨɛɿɜ.
435
1 2 3 4 5 6 7 8 9 10 11
ɍɫɶɨɝɨ
ɋɬɪɨɤɢ ɫɩɥɚɬɢ ɩɨɞɚɬɤɭ:
I ɤɜɚɪɬɚɥ __________________
(ɫɭɦɚ ɩɨɞɚɬɤɭ)
ɝɪɧ. ɞɨ _________________
(ɱɢɫɥɨ, ɦɿɫɹɰɶ)
200_ ɪ. (25 % ɫɭɦɢ ɝɪ. 11)
II ɤɜɚɪɬɚɥ __________________
(ɫɭɦɚ ɩɨɞɚɬɤɭ)
ɝɪɧ. ɞɨ _________________
(ɱɢɫɥɨ, ɦɿɫɹɰɶ)
200_ ɪ. (25 % ɫɭɦɢ ɝɪ. 11)
III ɤɜɚɪɬɚɥ __________________
(ɫɭɦɚ ɩɨɞɚɬɤɭ)
ɝɪɧ. ɞɨ _________________
(ɱɢɫɥɨ, ɦɿɫɹɰɶ)
200_ ɪ. (25 % ɫɭɦɢ ɝɪ. 11)
IV ɤɜɚɪɬɚɥ __________________
(ɫɭɦɚ ɩɨɞɚɬɤɭ)
ɝɪɧ. ɞɨ _________________
(ɱɢɫɥɨ, ɦɿɫɹɰɶ)
200_ ɪ. (25 % ɫɭɦɢ ɝɪ. 11)
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ (ɨɪɝɚɧɿɡɚɰɿʀ) _________
(ɩɿɞɩɢɫ)
_________________________________________
(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)
Ɇ. ɉ.
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ __________
(ɩɿɞɩɢɫ)
_____________________________________________________
(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)
"___" _______________ 200_ ɪ.
Ɂɚ ɞɚɧɢɦɢ ɨɪɝɚɧɭ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ:
Ɋɨɡɪɚɯɭɧɨɤ ɩɟɪɟɜɿɪɢɜ:
ɉɪɚɰɿɜɧɢɤ ɨɪɝɚɧɭ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ ___________
(ɩɿɞɩɢɫ)
________________________________
(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)
"___" _______________ 200_ ɪ.
Ɉɫɨɛɨɜɢɣ ɪɚɯɭɧɨɤ ɜɿɞɤɪɢɬɨ ɡɚ N __________________ ɡɚ ɜɢɳɟɡɚɡɧɚɱɟɧɢɦɢ ɬɟɪɦɿɧɚɦɢ ɫɩɥɚɬɢ
ɉɪɚɰɿɜɧɢɤ ɜɿɞɞɿɥɭ ɨɛɥɿɤɭ ɿ ɡɜɿɬɧɨɫɬɿ ɨɪɝɚɧɭ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ _____________
(ɩɿɞɩɢɫ)
_________________________________
(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)
"___" _______________ 200_ ɪ.
Ɂɚɬɜɟɪɞɠɭɸ:
Ʉɟɪɿɜɧɢɤ /ɡɚɫɬɭɩɧɢɤ ɤɟɪɿɜɧɢɤɚ/ ɨɪɝɚɧɭ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ _____________
(ɩɿɞɩɢɫ)
____________________________
(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)
436
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ
ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 17 ɜɟɪɟɫɧɹ 2001 ɪ. N 373
ȾɈȼȱȾɄȺ
ɩɪɨ ɫɭɦɢ ɩɨɞɚɬɤɭ ɡ ɜɥɚɫɧɢɤɿɜ ɬɪɚɧɫɩɨɪɬɧɢɯ ɡɚɫɨɛɿɜ ɬɚ ɿɧɲɢɯ ɫɚɦɨɯɿɞɧɢɯ ɦɚɲɢɧ ɿ
ɦɟɯɚɧɿɡɦɿɜ, ɹɤɿ ɡɦɟɧɲɭɸɬɶ ɚɛɨ ɡɛɿɥɶɲɭɸɬɶ ɩɨɞɚɬɤɨɜɿ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɜ ɪɟɡɭɥɶɬɚɬɿ
ɜɢɩɪɚɜɥɟɧɧɹ ɫɚɦɨɫɬɿɣɧɨ ɜɢɹɜɥɟɧɨʀ ɩɨɦɢɥɤɢ, ɞɨɩɭɳɟɧɨʀ ɜ ɩɨɩɟɪɟɞɧɿɯ ɡɜɿɬɧɢɯ
ɩɟɪɿɨɞɚɯ
(ɩɨɞɚɽɬɶɫɹ ɪɚɡɨɦ ɡ ɭɬɨɱɧɟɧɢɦ Ɋɨɡɪɚɯɭɧɤɨɦ ɨɤɪɟɦɨ ɡɚ ɤɨɠɧɢɣ ɡɜɿɬɧɢɣ ɩɟɪɿɨɞ)
Ɂɜɿɬɧɢɣ ɩɟɪɿɨɞ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ _____________________________________________________________
(ɪɿɤ)
ɉɥɚɬɧɢɤ _________________________________________________________________________________
(ɧɚɡɜɚ ɩɿɞɩɪɢɽɦɫɬɜɚ, ɭɫɬɚɧɨɜɢ, ɨɪɝɚɧɿɡɚɰɿʀ)
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɩɥɚɬɧɢɤɚ ɡɝɿɞɧɨ ɡ ȯȾɊɉɈɍ
Ɋɟɽɫɬɪɚɰɿɣɧɢɣ ɧɨɦɟɪ ɞɨɤɭɦɟɧɬɚ,
ɡ ɹɤɢɦ ɩɨɞɚɧɨ ɞɨɜɿɞɤɭ
N _______________________
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ
Ɍɟɥɟɮɨɧ
N
ɡ/ɩ
ɉɨɤɚɡɧɢɤɢ, ɳɨ ɜɩɥɢɜɚɸɬɶ ɧɚ ɫɭɦɢ
ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɜ ɤɚɪɬɰɿ ɨɫɨɛɨɜɨɝɨ
ɪɚɯɭɧɤɭ
Ɂɧɚɱɟɧɧɹ ɩɨɤɚɡɧɢɤɿɜ
1 2 3
1 ɋɭɦɚ ɩɨɞɚɬɤɭ, ɳɨ ɩɿɞɥɹɝɚɽ ɫɩɥɚɬɿ ɡɿ ɫɬɚɪɨɝɨ
Ɋɨɡɪɚɯɭɧɤɭ (ɡɚɝɚɥɶɧɨɝɨ ɚɛɨ ɩɨɩɟɪɟɞɧɶɨ
ɭɬɨɱɧɟɧɨɝɨ) (ɭɫɶɨɝɨ ɡɚ ɝɪ. 11 ɡɚɝɚɥɶɧɨɝɨ ɚɛɨ
ɩɨɩɟɪɟɞɧɶɨ ɭɬɨɱɧɟɧɨɝɨ Ɋɨɡɪɚɯɭɧɤɭ)
2 ɋɭɦɚ ɩɨɞɚɬɤɭ, ɳɨ ɩɿɞɥɹɝɚɽ ɫɩɥɚɬɿ ɡ ɭɬɨɱɧɟɧɨɝɨ
Ɋɨɡɪɚɯɭɧɤɭ (ɭɫɶɨɝɨ ɡɚ ɝɪ. 11 ɭɬɨɱɧɟɧɨɝɨ
Ɋɨɡɪɚɯɭɧɤɭ)
3 ɋɭɦɚ, ɹɤɚ ɡɛɿɥɶɲɭɽ (+) ɩɨɞɚɬɨɤ ɭ ɡɜ'ɹɡɤɭ ɡ
ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɪɹɞɨɤ 2 Ⱦɨɜɿɞɤɢ -
ɪɹɞɨɤ 1 Ⱦɨɜɿɞɤɢ)
4 ɋɭɦɚ, ɹɤɚ ɡɦɟɧɲɭɽ (-) ɩɨɞɚɬɨɤ ɭ ɡɜ'ɹɡɤɭ ɡ
ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɪɹɞɨɤ 1 Ⱦɨɜɿɞɤɢ -
ɪɹɞɨɤ 2 Ⱦɨɜɿɞɤɢ)
5 Ɂɦɿɫɬ
ɩɨɦɢɥɤɢ
6 ɒɬɪɚɮ 10 % (ɪɹɞɨɤ 3 ɯ 10 : 100)
Ⱦɚɬɚ ɩɨɞɚɧɧɹ Ⱦɨɜɿɞɤɢ
"___" _______________ 200_ ɪ.
ɇɚɜɟɞɟɧɚ ɿɧɮɨɪɦɚɰɿɹ ɽ ɜɿɪɧɨɸ.
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ (ɨɪɝɚɧɿɡɚɰɿʀ) _________________
(ɩɿɞɩɢɫ)
________________________
(ɩɪɿɡɜɢɳɟ)
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ _________________
(ɩɿɞɩɢɫ)
________________________
(ɩɪɿɡɜɢɳɟ)
Ɇ. ɉ.
437
ȼɿɞɦɿɬɤɚ ɩɪɨ ɨɞɟɪɠɚɧɧɹ (ɲɬɚɦɩ Ⱦɉȱ)
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 24 ɝɪɭɞɧɹ 2003 ɪ. N 625
ɉɈȾȺɌɄɈȼɂɃ ɊɈɁɊȺɏɍɇɈɄ ɄɈɆɍɇȺɅɖɇɈȽɈ ɉɈȾȺɌɄɍ
Ɂɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
1
ɇɨɜɢɣ ɡɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
ɍɬɨɱɧɸɸɱɢɣ ɪɨɡɪɚɯɭɧɨɤ
ɘɪɢɞɢɱɧɚ ɨɫɨɛɚ
Ȼɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ ɡɚ 20 ɪɨɤɭ
2
ɉɨɪɹɞɤɨɜɢɣ ɧɨɦɟɪ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ, ɹɤɢɣ ɜɢɡɧɚɱɟɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɿɲɟɧɧɹ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ
ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɤɨɦɭɧɚɥɶɧɨɝɨ ɩɨɞɚɬɤɭ, ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɚɪɚɛɫɶɤɢɦɢ ɰɢɮɪɚɦɢ (ɞɥɹ ɱɢɫɟɥ ɡ ɨɞɧɿɽʀ ɰɢɮɪɢ ɜ ɩɟɪɲɨɦɭ ɩɨɥɿ
ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ "0", ɞɥɹ ɪɿɱɧɨɝɨ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ "0" ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɜ ɩɟɪɲɨɦɭ ɿ ɞɪɭɝɨɦɭ ɩɨɥɹɯ)
ɦɿɫɹɰɶ ɤɜɚɪɬɚɥ ɪɿɤ Ɍɪɢɜɚɥɿɫɬɶ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ ɡɚɡɧɚɱɚɽɬɶɫɹ ɩɨɡɧɚɱɤɨɸ "ɯ"
3
ɉɨɜɧɚ ɧɚɡɜɚ ɩɥɚɬɧɢɤɚ: ____________________________________________________________________
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ
4
Ʉɨɞ ɜɢɞɭ ɟɤɨɧɨɦɿɱɧɨʀ ɞɿɹɥɶɧɨɫɬɿ (ɄȼȿȾ) ƒ ƒ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ: _________________________________ ɉɨɲɬɨɜɢɣ ɿɧɞɟɤɫ
___________________________________________________________ Ɇɿɠɦɿɫɶɤɢɣ ɤɨɞ
Ɍɟɥɟɮɨɧ
5
ȿ-mail Ɏɚɤɫ
6
Ⱦɨ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ (ɚɞɦɿɧɿɫɬɪɚɰɿʀ) ɜ :__________________________________________________
7
Ʉɨɞ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɡɚ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹɦ ɨɛ'ɽɤɬɚ ɨɩɨɞɚɬɤɭɜɚɧɧɹ ɡɚ
ɄɈȺɌɍɍ
Ɉɞɢɧɢɰɹ ɜɢɦɿɪɭ - ɝɪɧ. ɤɨɩ.
ɉɨɤɚɡɧɢɤɢ
Ʉɨɞ ɪɹɞɤɚ
ɍɫɶɨɝɨ
Ʉɿɥɶɤɿɫɧɢɣ ɫɤɥɚɞ ɩɪɚɰɿɜɧɢɤɿɜ* ɡɚ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ 01
ɇɟɨɩɨɞɚɬɤɨɜɭɜɚɧɢɣ ɦɿɧɿɦɭɦ ɞɨɯɨɞɿɜ ɝɪɨɦɚɞɹɧ** 02
ƒ
Ɋɿɱɧɢɣ ɮɨɧɞ ɨɩɥɚɬɢ ɩɪɚɰɿ (ɪ. 01 ɯ ɪ. 02) 03
ƒ
ɋɬɚɜɤɚ ɤɨɦɭɧɚɥɶɧɨɝɨ ɩɨɞɚɬɤɭ***, % 04
ƒ
ɇɚɪɚɯɨɜɚɧɨ ɩɨɞɚɬɤɭ ɡɚ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ (ɪ. 03 ɯ ɪ. 04) 05
ƒ
ɇɚɪɚɯɨɜɚɧɨ ɩɨɞɚɬɤɭ ɡɚ ɞɚɧɢɦɢ ɪɚɧɿɲɟ ɩɨɞɚɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ,
ɭɫɶɨɝɨ (ɪ. 05 ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ)****
06
ƒ
ɋɭɦɚ ɧɟɞɨɩɥɚɬɢ (ɡɚɧɢɠɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ), ɹɤɚ ɡɛɿɥɶɲɭɽ ɩɨɞɚɬɤɨɜɟ
ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 05 - ɪ. 06)****,
ɹɤɳɨ ɪ. 05 > ɪ. 06
07
ƒ
ɋɭɦɚ ɩɨɞɚɬɤɭ, ɹɤɚ ɡɦɟɧɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ
ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 06 - ɪ. 05)****, ɹɤɳɨ ɪ. 06 > ɪ. 05
08
ƒ
ɋɭɦɚ ɲɬɪɚɮɭ***** (ɪ. 07) ɯ 5 % 09
ƒ
Ɂɦɿɫɬ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ)****
10
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɩɿɞɩɭɧɤɬɭ "ɛ" ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ
ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ) ɞɨ ɰɶɨɝɨ ɡɜɿɬɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ
ɞɨɞɚɽɬɶɫɹ(ɸɬɶɫɹ) ɭɬɨɱɧɸɸɱɢɣ(ɿ) ɪɨɡɪɚɯɭɧɨɤ(ɤɢ) ɡɚ "_______________________" (ɦɢɧɭɥɢɣ(ɿ) ɩɟɪɿɨɞ(ɢ)).
____________
* Ʉɿɥɶɤɿɫɧɢɣ ɫɤɥɚɞ ɩɪɚɰɿɜɧɢɤɿɜ ɡɚ ɜɿɞɩɨɜɿɞɧɢɣ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ
ɞɨɪɿɜɧɸɽ ɩɨɤɚɡɧɢɤɭ ɫɟɪɟɞɧɶɨɨɛɥɿɤɨɜɨʀ ɤɿɥɶɤɨɫɬɿ
ɲɬɚɬɧɢɯ ɩɪɚɰɿɜɧɢɤɿɜ, ɜɢɡɧɚɱɟɧɨɦɭ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ȱɧɫɬɪɭɤɰɿʀ ɡɿ ɫɬɚɬɢɫɬɢɤɢ ɤɿɥɶɤɨɫɬɿ ɩɪɚɰɿɜɧɢɤɿɜ, ɡɚɬɜɟɪɞɠɟɧɨʀ ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨɝɨ
ɤɨɦɿɬɟɬɭ ɫɬɚɬɢɫɬɢɤɢ ɍɤɪɚʀɧɢ ɜɿɞ 28.09.2005 N 286, ɡɚɪɟɽɫɬɪɨɜɚɧɨʀ ɭ Ɇɿɧɿɫɬɟɪɫɬɜɿ ɸɫɬɢɰɿʀ ɍɤɪɚʀɧɢ 30.11.2005 ɡɚ N 1442/11722. ɉɪɢ ɰɶɨɦɭ,
ɹɤɳɨ ɪɿɲɟɧɧɹɦ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɤɨɦɭɧɚɥɶɧɨɝɨ ɩɨɞɚɬɤɭ ɜɢɡɧɚɱɟɧɨ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ
ɤɚɥɟɧɞɚɪɧɢɣ ɦɿɫɹɰɶ, ɬɨ ɜ ɪɹɞɤɭ 01 ɭɤɚɡɭɽɬɶɫɹ ɫɟɪɟɞɧɶɨɨɛɥɿɤɨɜɚ
ɤɿɥɶɤɿɫɬɶ ɲɬɚɬɧɢɯ ɩɪɚɰɿɜɧɢɤɿɜ ɡɚ ɬɚɤɢɣ ɦɿɫɹɰɶ, ɹɤɳɨ ɤɚɥɟɧɞɚɪɧɢɣ ɤɜɚɪɬɚɥ
(ɩɿɜɪɿɱɱɹ, ɪɿɤ) – ɫɭɦɚ ɫɟɪɟɞɧɶɨɨɛɥɿɤɨɜɨʀ ɤɿɥɶɤɨɫɬɿ ɲɬɚɬɧɢɯ ɩɪɚɰɿɜɧɢɤɿɜ ɡɚ ɤɨɠɟɧ ɦɿɫɹɰɶ ɤɜɚɪɬɚɥɭ (ɩɿɜɪɿɱɱɹ, ɪɨɤɭ).
** ɉɪɨɫɬɚɜɥɹɽɬɶɫɹ ɪɨɡɦɿɪ ɧɟɨɩɨɞɚɬɤɨɜɭɜɚɧɨɝɨ ɦɿɧɿɦɭɦɭ ɞɨɯɨɞɿɜ ɝɪɨɦɚɞɹɧ, ɭɫɬɚɧɨɜɥɟɧɢɣ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ ɍɤɪɚʀɧɢ.
*** ɉɪɨɫɬɚɜɥɹɽɬɶɫɹ ɫɬɚɜɤɚ, ɜɢɡɧɚɱɟɧɚ ɪɿɲɟɧɧɹɦ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɤɨɦɭɧɚɥɶɧɨɝɨ ɩɨɞɚɬɤɭ.
**** Ɂɚɩɨɜɧɸɽɬɶɫɹ ɭ ɪɚɡɿ ɩɨɞɚɧɧɹ ɭɬɨɱɧɸɸɱɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ
ɦɿɫɬɢɬɶ ɜɢɩɪɚɜɥɟɧɿ ɩɨɤɚɡɧɢɤɢ.
***** ɇɚɪɚɯɨɜɭɽɬɶɫɹ ɩɥɚɬɧɢɤɨɦ ɫɚɦɨɫɬɿɣɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ
ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɜɧɟɫɟɧɢɦɢ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ).
Ⱦɚɬɚ ɡɚɩɨɜɧɟɧɧɹ ɪɨɡɪɚɯɭɧɤɭ (ɞɞ.ɦɦ.ɪɪɪɪ.)
ƒ ƒ
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ
___________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
Ɇ. ɉ.
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ
___________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
ɐɹ ɱɚɫɬɢɧɚ ɪɨɡɪɚɯɭɧɤɭ ɡɚɩɨɜɧɸɽɬɶɫɹ ɩɨɫɚɞɨɜɢɦɢ ɨɫɨɛɚɦɢ Ⱦɉȱ (ȾɉȺ)
ȼɿɞɦɿɬɤɚ ɩɪɨ ɜɧɟɫɟɧɧɹ ɞɚɧɢɯ ɞɨ ɟɥɟɤɬɪɨɧɧɨʀ ɛɚɡɢ ɩɨɞɚɬɤɨɜɨʀ ɡɜɿɬɧɨɫɬɿ
"___" ____________ 200_ ɪ.
______________________________________________________________________________________
_
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɚɦɟɪɚɥɶɧɨʀ ɩɟɪɟɜɿɪɤɢ ɪɨɡɪɚɯɭɧɤɭ (ɩɨɬɪɿɛɧɟ ɩɨɡɧɚɱɢɬɢ):
ɩɨɪɭɲɟɧɶ (ɩɨɦɢɥɨɤ) ɧɟ ɜɢɹɜɥɟɧɨ ɫɤɥɚɞɟɧɨ ɚɤɬ ɜɿɞ "___" ____________ 200_ ɪ. N __________
"___" ____________ 200_ ɪ. ___________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
438
ȼɿɞɦɿɬɤɚ ɩɪɨ ɨɞɟɪɠɚɧɧɹ (ɲɬɚɦɩ Ⱦɉȱ)
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ
ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 24 ɝɪɭɞɧɹ 2003 ɪ. N 622
ɉɈȾȺɌɄɈȼɂɃ ɊɈɁɊȺɏɍɇɈɄ ɁȻɈɊɍ ɁȺ ɉɊȺȼɈ ȼɂɄɈɊɂɋɌȺɇɇə ɆȱɋɐȿȼɈȲ ɋɂɆȼɈɅȱɄɂ
Ɂɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
1
ɇɨɜɢɣ ɡɜɿɬɧɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɍɬɨɱɧɸɸɱɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɘɪɢɞɢɱɧɚ ɨɫɨɛɚ
Ɏɿɡɢɱɧɚ ɨɫɨɛɚ - ɫɭɛ'ɽɤɬ
ɩɿɞɩɪɢɽɦɧɢɰɶɤɨʀ
ɞɿɹɥɶɧɨɫɬɿ
Ȼɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ ɡɚ
2 0
ɪɨɤɭ
2
ɉɨɪɹɞɤɨɜɢɣ ɧɨɦɟɪ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ, ɹɤɢɣ ɜɢɡɧɚɱɟɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɿɲɟɧɧɹ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ
ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɡɛɨɪɭ ɡɚ ɩɪɚɜɨ ɜɢɤɨɪɢɫɬɚɧɧɹ ɦɿɫɰɟɜɨʀ ɫɢɦɜɨɥɿɤɢ, ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɚɪɚɛɫɶɤɢɦɢ ɰɢɮɪɚɦɢ (ɞɥɹ ɱɢɫɟɥ ɡ ɨɞɧɿɽʀ ɰɢɮɪɢ ɜ
ɩɟɪɲɨɦɭ ɩɨɥɿ ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ "0", ɞɥɹ ɪɿɱɧɨɝɨ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ "0" ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɜ ɩɟɪɲɨɦɭ ɿ ɞɪɭɝɨɦɭ
ɩɨɥɹɯ)
ɦɿɫɹɰɶ
ɤɜɚɪɬɚɥ
ɪɿɤ
Ɍɪɢɜɚɥɿɫɬɶ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ ɡɚɡɧɚɱɚɽɬɶɫɹ ɩɨɡɧɚɱɤɨɸ "ɯ"
3
ɉɨɜɧɚ ɧɚɡɜɚ ɩɥɚɬɧɢɤɚ:
________________________________________________________________________________
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ ɚɛɨ ɿɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɧɨɦɟɪ ɡ ȾɊɎɈ
4
Ʉɨɞ ɜɢɞɭ ɟɤɨɧɨɦɿɱɧɨʀ ɞɿɹɥɶɧɨɫɬɿ (ɄȼȿȾ) ƒ ƒ
ɉɨɲɬɨɜɢɣ ɿɧɞɟɤɫ
Ɇɿɠɦɿɫɶɤɢɣ ɤɨɞ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ: ____________________________________________
_________________________________________________________________
Ɍɟɥɟɮɨɧ
5
ȿ-mail Ɏɚɤɫ
6
Ⱦɨ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ (ɚɞɦɿɧɿɫɬɪɚɰɿʀ) ɜ: ____________________________________________________________________
7
Ʉɨɞ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɡɚ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹɦ ɨɛ'ɽɤɬɚ ɨɩɨɞɚɬɤɭɜɚɧɧɹ
ɡɚ ɄɈȺɌɍɍ
Ɉɞɢɧɢɰɹ ɜɢɦɿɪɭ - ɝɪɧ. ɤɨɩ.
ɉɨɤɚɡɧɢɤɢ Ʉɨɞ ɪɹɞɤɚ ɍɫɶɨɝɨ
ȼɚɪɬɿɫɬɶ ɜɢɪɨɛɥɟɧɨʀ ɩɪɨɞɭɤɰɿʀ, ɜɢɤɨɧɚɧɢɯ ɪɨɛɿɬ, ɧɚɞɚɧɢɯ ɩɨɫɥɭɝ ɡ ɜɢɤɨɪɢɫɬɚɧɧɹɦ
ɦɿɫɰɟɜɨʀ ɫɢɦɜɨɥɿɤɢ ɸɪɢɞɢɱɧɢɦɢ ɨɫɨɛɚɦɢ
01
ƒ
ɋɬɚɜɤɚ ɡɛɨɪɭ ɡɚ ɜɢɤɨɪɢɫɬɚɧɧɹ ɦɿɫɰɟɜɨʀ ɫɢɦɜɨɥɿɤɢ ɞɥɹ ɸɪɢɞɢɱɧɢɯ ɨɫɿɛ*, %. 02 ƒ
ɇɚɪɚɯɨɜɚɧɨ ɡɛɨɪɭ ɡɚ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ (ɪ. 01 ɯ ɪ. 02) 03 ƒ
ɇɚɪɚɯɨɜɚɧɨ ɡɛɨɪɭ ɮɿɡɢɱɧɢɦɢ ɨɫɨɛɚɦɢ - ɫɭɛ'ɽɤɬɚɦɢ ɩɿɞɩɪɢɽɦɧɢɰɶɤɨʀ ɞɿɹɥɶɧɨɫɬɿ*, ɡɚ
ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ
04
ƒ
ɇɚɪɚɯɨɜɚɧɨ ɡɛɨɪɭ ɡɚ ɞɚɧɢɦɢ ɪɚɧɿɲɟ ɩɨɞɚɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ, ɭɫɶɨɝɨ
(ɪ. 03 ɚɛɨ ɪ. 04 ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ)**
05
ƒ
ɋɭɦɚ ɧɟɞɨɩɥɚɬɢ (ɡɚɧɢɠɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ), ɹɤɚ ɡɛɿɥɶɲɭɽ ɩɨɞɚɬɤɨɜɟ
ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 03 ɚɛɨ ɪ. 04 - ɪ. 05)**,
ɹɤɳɨ ɪ. 03 ɚɛɨ ɪ. 04 > ɪ. 05
06
ƒ
ɋɭɦɚ ɡɛɨɪɭ, ɹɤɚ ɡɦɟɧɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ
(ɩɨɦɢɥɨɤ) (ɪ. 05 - ɪ. 03 ɚɛɨ ɪ. 04)**, ɹɤɳɨ ɪ. 05 > ɪ. 03 ɚɛɨ ɪ. 04
07
ƒ
ɋɭɦɚ ɲɬɪɚɮɭ*** (ɪ. 06) ɯ 5 % 08 ƒ
Ɂɦɿɫɬ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ)**
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɩɿɞɩɭɧɤɬɭ "ɛ" ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ
ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ) ɞɨ ɰɶɨɝɨ ɡɜɿɬɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ
ɞɨɞɚɽɬɶɫɹ(ɸɬɶɫɹ) ɭɬɨɱɧɸɸɱɢɣ(ɿ) ɪɨɡɪɚɯɭɧɨɤ(ɤɢ) ɡɚ "_______________________" (ɦɢɧɭɥɢɣ(ɿ) ɩɟɪɿɨɞ(ɢ)).
____________
*
ɉɪɨɫɬɚɜɥɹɽɬɶɫɹ ɜɿɞɩɨɜɿɞɧɚ ɫɬɚɜɤɚ ɚɛɨ ɫɭɦɚ, ɜɢɡɧɚɱɟɧɚ ɪɿɲɟɧɧɹɦ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɡɛɨɪɭ ɡɚ ɩɪɚɜɨ ɜɢɤɨɪɢɫɬɚɧɧɹ
ɦɿɫɰɟɜɨʀ ɫɢɦɜɨɥɿɤɢ.
** Ɂɚɩɨɜɧɸɽɬɶɫɹ ɭ ɪɚɡɿ ɩɨɞɚɧɧɹ ɭɬɨɱɧɸɸɱɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɦɿɫɬɢɬɶ ɜɢɩɪɚɜɥɟɧɿ ɩɨɤɚɡɧɢɤɢ.
*** ɇɚɪɚɯɨɜɭɽɬɶɫɹ ɩɥɚɬɧɢɤɨɦ ɫɚɦɨɫɬɿɣɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ
ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɜɧɟɫɟɧɢɦɢ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ).
Ⱦɚɬɚ ɡɚɩɨɜɧɟɧɧɹ ɪɨɡɪɚɯɭɧɤɭ (ɞɞ.ɦɦ.ɪɪɪɪ.)
.
.
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ
_______________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ
_______________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
Ɇ. ɉ.
ɐɹ ɱɚɫɬɢɧɚ ɪɨɡɪɚɯɭɧɤɭ ɡɚɩɨɜɧɸɽɬɶɫɹ ɩɨɫɚɞɨɜɢɦɢ ɨɫɨɛɚɦɢ Ⱦɉȱ (ȾɉȺ)
ȼɿɞɦɿɬɤɚ ɩɪɨ ɜɧɟɫɟɧɧɹ ɞɚɧɢɯ ɞɨ ɟɥɟɤɬɪɨɧɧɨʀ ɛɚɡɢ ɩɨɞɚɬɤɨɜɨʀ ɡɜɿɬɧɨɫɬɿ "___" ____________ 200_ ɪ.
__________________________________________________________________________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɚɦɟɪɚɥɶɧɨʀ ɩɟɪɟɜɿɪɤɢ ɪɨɡɪɚɯɭɧɤɭ (ɩɨɬɪɿɛɧɟ ɩɨɡɧɚɱɢɬɢ):
ɩɨɪɭɲɟɧɶ (ɩɨɦɢɥɨɤ) ɧɟ ɜɢɹɜɥɟɧɨ ɫɤɥɚɞɟɧɨ ɚɤɬ ɜɿɞ "___" ____________ 200_ ɪ. N __________
"___" ____________ 200_ ɪ.
___________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
439
ȼɿɞɦɿɬɤɚ ɩɪɨ ɨɞɟɪɠɚɧɧɹ (ɲɬɚɦɩ Ⱦɉȱ)
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ
ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 24 ɝɪɭɞɧɹ 2003 ɪ. N 629
ɉɈȾȺɌɄɈȼɂɃ ɊɈɁɊȺɏɍɇɈɄ ɁȻɈɊɍ ɁȺ ɉɊɂɉȺɊɄɍȼȺɇɇə ȺȼɌɈɌɊȺɇɋɉɈɊɌɍ
Ɂɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
1
ɇɨɜɢɣ ɡɜɿɬɧɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɍɬɨɱɧɸɸɱɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɘɪɢɞɢɱɧɚ ɨɫɨɛɚ
Ɏɿɡɢɱɧɚ ɨɫɨɛɚ - ɫɭɛ'ɽɤɬ
ɩɿɞɩɪɢɽɦɧɢɰɶɤɨʀ
ɞɿɹɥɶɧɨɫɬɿ
Ȼɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ ɡɚ
2 0
ɪɨɤɭ
2
ɉɨɪɹɞɤɨɜɢɣ ɧɨɦɟɪ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ, ɹɤɢɣ ɜɢɡɧɚɱɟɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɿɲɟɧɧɹ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ
ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɡɛɨɪɭ ɡɚ ɩɪɢɩɚɪɤɭɜɚɧɧɹ ɚɜɬɨɬɪɚɧɫɩɨɪɬɭ, ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɚɪɚɛɫɶɤɢɦɢ ɰɢɮɪɚɦɢ (ɞɥɹ ɱɢɫɟɥ ɡ ɨɞɧɿɽʀ ɰɢɮɪɢ ɜ ɩɟɪɲɨɦɭ
ɩɨɥɿ ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ "0", ɞɥɹ ɪɿɱɧɨɝɨ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ "0" ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɜ ɩɟɪɲɨɦɭ ɿ ɞɪɭɝɨɦɭ ɩɨɥɹɯ)
ɦɿɫɹɰɶ
ɤɜɚɪɬɚɥ
ɪɿɤ
Ɍɪɢɜɚɥɿɫɬɶ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ ɡɚɡɧɚɱɚɽɬɶɫɹ ɩɨɡɧɚɱɤɨɸ "ɯ"
3
ɉɨɜɧɚ ɧɚɡɜɚ ɩɥɚɬɧɢɤɚ:
________________________________________________________________________________
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ ɚɛɨ ɿɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɧɨɦɟɪ ɡ ȾɊɎɈ
4
Ʉɨɞ ɜɢɞɭ ɟɤɨɧɨɦɿɱɧɨʀ ɞɿɹɥɶɧɨɫɬɿ (ɄȼȿȾ) ƒ ƒ
ɉɨɲɬɨɜɢɣ ɿɧɞɟɤɫ
Ɇɿɠɦɿɫɶɤɢɣ ɤɨɞ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ: ____________________________________________
_________________________________________________________________
Ɍɟɥɟɮɨɧ
5
ȿ-mail Ɏɚɤɫ
6
Ⱦɨ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ (ɚɞɦɿɧɿɫɬɪɚɰɿʀ) ɜ: ____________________________________________________________________
7
Ʉɨɞ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɡɚ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹɦ ɨɛ'ɽɤɬɚ ɨɩɨɞɚɬɤɭɜɚɧɧɹ
ɡɚ ɄɈȺɌɍɍ
Ɉɞɢɧɢɰɹ ɜɢɦɿɪɭ - ɝɪɧ. ɤɨɩ.
ɉɨɤɚɡɧɢɤɢ Ʉɨɞ ɪɹɞ. ɍɫɶɨɝɨ
ɍɬɪɢɦɚɧɨ ɡɛɨɪɭ ɜɩɨɜɧɨɜɚɠɟɧɨɸ ɨɫɨɛɨɸ - ɩɥɚɬɧɢɤɨɦ ɡɛɨɪɭ* ɡɚ ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ
(ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ
01
ƒ
ɍɬɪɢɦɚɧɨ ɡɛɨɪɭ ɜɩɨɜɧɨɜɚɠɟɧɨɸ ɨɫɨɛɨɸ - ɩɥɚɬɧɢɤɨɦ ɡɛɨɪɭ* ɡɚ ɞɚɧɢɦɢ ɪɚɧɿɲɟ
ɩɨɞɚɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ, ɭɫɶɨɝɨ (ɪ. 01 ɪɨɡɪɚɯɭɧɤɭ, ɳɨ
ɭɬɨɱɧɸɽɬɶɫɹ)**
02
ƒ
ɋɭɦɚ ɧɟɞɨɩɥɚɬɢ (ɡɚɧɢɠɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ), ɹɤɚ ɡɛɿɥɶɲɭɽ ɩɨɞɚɬɤɨɜɟ
ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 01 - ɪ. 02)**,
ɹɤɳɨ ɪ. 01 > ɪ. 02
03
ƒ
ɋɭɦɚ ɡɛɨɪɭ, ɹɤɚ ɡɦɟɧɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ
(ɩɨɦɢɥɨɤ) (ɪ. 02 - ɪ. 01)**, ɹɤɳɨ ɪ. 02 > ɪ. 01
04
ƒ
ɋɭɦɚ ɲɬɪɚɮɭ*** (ɪ. 03) ɯ 5 % 05 ƒ
Ɂɦɿɫɬ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ)**
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɩɿɞɩɭɧɤɬɭ "ɛ" ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ
ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ) ɞɨ ɰɶɨɝɨ ɡɜɿɬɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ
ɞɨɞɚɽɬɶɫɹ(ɸɬɶɫɹ) ɭɬɨɱɧɸɸɱɢɣ(ɿ) ɪɨɡɪɚɯɭɧɨɤ(ɤɢ) ɡɚ "_______________________" (ɦɢɧɭɥɢɣ(ɿ) ɩɟɪɿɨɞ(ɢ)).
____________
*
ȼɩɨɜɧɨɜɚɠɟɧɚ ɨɫɨɛɚ - ɩɥɚɬɧɢɤ ɡɛɨɪɭ ɜɢɡɧɚɱɚɽɬɶɫɹ ɪɿɲɟɧɧɹɦ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɡɛɨɪɭ ɡɚ ɩɪɢɩɚɪɤɭɜɚɧɧɹ ɚɜɬɨɬɪɚɧɫɩɨɪɬɭ.
** Ɂɚɩɨɜɧɸɽɬɶɫɹ ɭ ɪɚɡɿ ɩɨɞɚɧɧɹ ɭɬɨɱɧɸɸɱɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɦɿɫɬɢɬɶ ɜɢɩɪɚɜɥɟɧɿ ɩɨɤɚɡɧɢɤɢ.
*** ɇɚɪɚɯɨɜɭɽɬɶɫɹ ɩɥɚɬɧɢɤɨɦ ɫɚɦɨɫɬɿɣɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ
ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɜɧɟɫɟɧɢɦɢ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ).
Ⱦɚɬɚ ɡɚɩɨɜɧɟɧɧɹ ɪɨɡɪɚɯɭɧɤɭ (ɞɞ.ɦɦ.ɪɪɪɪ.)
.
.
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ
_______________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ
_______________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
____________
(ɩɿɞɩɢɫ)
Ɇ. ɉ.
ɐɹ ɱɚɫɬɢɧɚ ɪɨɡɪɚɯɭɧɤɭ ɡɚɩɨɜɧɸɽɬɶɫɹ ɩɨɫɚɞɨɜɢɦɢ ɨɫɨɛɚɦɢ Ⱦɉȱ (ȾɉȺ)
ȼɿɞɦɿɬɤɚ ɩɪɨ ɜɧɟɫɟɧɧɹ ɞɚɧɢɯ ɞɨ ɟɥɟɤɬɪɨɧɧɨʀ ɛɚɡɢ ɩɨɞɚɬɤɨɜɨʀ ɡɜɿɬɧɨɫɬɿ "___" ____________ 200_ ɪ.
__________________________________________________________________________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɚɦɟɪɚɥɶɧɨʀ ɩɟɪɟɜɿɪɤɢ ɪɨɡɪɚɯɭɧɤɭ (ɩɨɬɪɿɛɧɟ ɩɨɡɧɚɱɢɬɢ):
ɩɨɪɭɲɟɧɶ (ɩɨɦɢɥɨɤ) ɧɟ ɜɢɹɜɥɟɧɨ ɫɤɥɚɞɟɧɨ ɚɤɬ ɜɿɞ "___" ____________ 200_ ɪ. N __________
"___" ____________ 200_ ɪ.
___________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
440
ȼɿɞɦɿɬɤɚ ɩɪɨ ɨɞɟɪɠɚɧɧɹ (ɲɬɚɦɩ Ⱦɉȱ)
ɁȺɌȼȿɊȾɀȿɇɈ
ɧɚɤɚɡɨɦ Ⱦɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ
ɚɞɦɿɧɿɫɬɪɚɰɿʀ ɍɤɪɚʀɧɢ
ɜɿɞ 24 ɝɪɭɞɧɹ 2003 ɪ. N 627
ɉɈȾȺɌɄɈȼɂɃ ɊɈɁɊȺɏɍɇɈɄ ɊɂɇɄɈȼɈȽɈ ɁȻɈɊɍ
Ɂɜɿɬɧɢɣ ɪɨɡɪɚɯɭɧɨɤ
1
ɇɨɜɢɣ ɡɜɿɬɧɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɍɬɨɱɧɸɸɱɢɣ
ɪɨɡɪɚɯɭɧɨɤ
ɘɪɢɞɢɱɧɚ ɨɫɨɛɚ
Ɏɿɡɢɱɧɚ ɨɫɨɛɚ - ɫɭɛ'ɽɤɬ
ɩɿɞɩɪɢɽɦɧɢɰɶɤɨʀ
ɞɿɹɥɶɧɨɫɬɿ
Ȼɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ ɡɚ 2 0 ɪɨɤɭ
2
ɉɨɪɹɞɤɨɜɢɣ ɧɨɦɟɪ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ, ɹɤɢɣ ɜɢɡɧɚɱɟɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɿɲɟɧɧɹ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ
ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɪɢɧɤɨɜɨɝɨ ɡɛɨɪɭ, ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɚɪɚɛɫɶɤɢɦɢ ɰɢɮɪɚɦɢ (ɞɥɹ ɱɢɫɟɥ ɡ ɨɞɧɿɽʀ ɰɢɮɪɢ ɜ ɩɟɪɲɨɦɭ ɩɨɥɿ ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ "0",
ɞɥɹ ɪɿɱɧɨɝɨ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ "0" ɩɪɨɫɬɚɜɥɹɽɬɶɫɹ ɜ ɩɟɪɲɨɦɭ ɿ ɞɪɭɝɨɦɭ ɩɨɥɹɯ)
ɦɿɫɹɰɶ ɤɜɚɪɬɚɥ ɪɿɤ Ɍɪɢɜɚɥɿɫɬɶ ɛɚɡɨɜɨɝɨ ɩɨɞɚɬɤɨɜɨɝɨ (ɡɜɿɬɧɨɝɨ) ɩɟɪɿɨɞɭ ɡɚɡɧɚɱɚɽɬɶɫɹ ɩɨɡɧɚɱɤɨɸ "ɯ"
3
ɉɨɜɧɚ ɧɚɡɜɚ ɩɥɚɬɧɢɤɚ: ____________________________________________________________________________
ȱɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ ɡɚ ȯȾɊɉɈɍ ɚɛɨ ɿɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɧɨɦɟɪ ɡ ȾɊɎɈ
4
Ʉɨɞ ɜɢɞɭ ɟɤɨɧɨɦɿɱɧɨʀ ɞɿɹɥɶɧɨɫɬɿ (ɄȼȿȾ) ƒ ƒ
ɉɨɲɬɨɜɢɣ ɿɧɞɟɤɫ
Ɇɿɠɦɿɫɶɤɢɣ ɤɨɞ
Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ: _________________________________________
__________________________________________________________________
Ɍɟɥɟɮɨɧ
5
ȿ-mail Ɏɚɤɫ
6
Ⱦɨ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɿɧɫɩɟɤɰɿʀ (ɚɞɦɿɧɿɫɬɪɚɰɿʀ) ɜ: ________________________________________________________________
7
Ʉɨɞ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɡɚ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹɦ ɨɛ'ɽɤɬɚ
ɨɩɨɞɚɬɤɭɜɚɧɧɹ ɡɚ ɄɈȺɌɍɍ
Ɉɞɢɧɢɰɹ ɜɢɦɿɪɭ - ɝɪɧ. ɤɨɩ.
ɉɨɤɚɡɧɢɤɢ Ʉɨɞ ɪɹɞ. ɍɫɶɨɝɨ
ɍɬɪɢɦɚɧɨ ɡɛɨɪɭ ɜɩɨɜɧɨɜɚɠɟɧɨɸ ɨɫɨɛɨɸ - ɩɥɚɬɧɢɤɨɦ ɡɛɨɪɭ* ɡɚ
ɛɚɡɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ (ɡɜɿɬɧɢɣ) ɩɟɪɿɨɞ
01
ƒ
ɍɬɪɢɦɚɧɨ ɡɛɨɪɭ ɜɩɨɜɧɨɜɚɠɟɧɨɸ ɨɫɨɛɨɸ - ɩɥɚɬɧɢɤɚ ɡɛɨɪɭ* ɡɚ
ɞɚɧɢɦɢ ɪɚɧɿɲɟ ɩɨɞɚɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ, ɭɫɶɨɝɨ
(ɪ. 01 ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɭɬɨɱɧɸɽɬɶɫɹ)**
02
ƒ
ɋɭɦɚ ɧɟɞɨɩɥɚɬɢ (ɡɚɧɢɠɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ'ɹɡɚɧɧɹ), ɹɤɚ
ɡɛɿɥɶɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ
(ɩɨɦɢɥɨɤ) (ɪ. 01 - ɪ. 02)**, ɹɤɳɨ ɪ. 01 > ɪ. 02
03
ƒ
ɋɭɦɚ ɡɛɨɪɭ, ɹɤɚ ɡɦɟɧɲɭɽ ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ'ɹɡɚɧɧɹ ɭ ɡɜ'ɹɡɤɭ ɡ
ɜɢɩɪɚɜɥɟɧɧɹɦ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) (ɪ. 02 - ɪ. 01)**,
ɹɤɳɨ ɪ. 02 > ɪ. 01
04
ƒ
ɋɭɦɚ ɲɬɪɚɮɭ*** (ɪ. 03) ɯ 5 %
05
ƒ
Ɂɦɿɫɬ ɩɨɦɢɥɤɢ (ɩɨɦɢɥɨɤ) **
ȼɿɞɩɨɜɿɞɧɨ ɞɨ ɩɿɞɩɭɧɤɬɭ "ɛ" ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ
ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ) ɞɨ ɰɶɨɝɨ ɡɜɿɬɧɨɝɨ ɪɨɡɪɚɯɭɧɤɭ
ɞɨɞɚɽɬɶɫɹ(ɸɬɶɫɹ) ɭɬɨɱɧɸɸɱɢɣ(ɿ) ɪɨɡɪɚɯɭɧɨɤ(ɤɢ) ɡɚ "_______________________" (ɦɢɧɭɥɢɣ(ɿ) ɩɟɪɿɨɞ(ɢ)).
____________
*
ȼɩɨɜɧɨɜɚɠɟɧɚ ɨɫɨɛɚ - ɩɥɚɬɧɢɤ ɡɛɨɪɭ ɜɢɡɧɚɱɚɽɬɶɫɹ ɪɿɲɟɧɧɹɦ ɨɪɝɚɧɭ ɦɿɫɰɟɜɨɝɨ ɫɚɦɨɜɪɹɞɭɜɚɧɧɹ ɩɪɨ ɜɫɬɚɧɨɜɥɟɧɧɹ ɪɢɧɤɨɜɨɝɨ ɡɛɨɪɭ.
** Ɂɚɩɨɜɧɸɽɬɶɫɹ ɭ ɪɚɡɿ ɩɨɞɚɧɧɹ ɭɬɨɱɧɸɸɱɨɝɨ ɪɨɡɪɚɯɭɧɤɭ, ɳɨ ɦɿɫɬɢɬɶ ɜɢɩɪɚɜɥɟɧɿ ɩɨɤɚɡɧɢɤɢ.
*** ɇɚɪɚɯɨɜɭɽɬɶɫɹ ɩɥɚɬɧɢɤɨɦ ɫɚɦɨɫɬɿɣɧɨ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɩɭɧɤɬɭ 17.2 ɫɬɚɬɬɿ 17 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ ɜɿɞ 21.12.2000 N 2181-III "ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ'ɹɡɚɧɶ
ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ" (ɿɡ ɜɧɟɫɟɧɢɦɢ ɡɦɿɧɚɦɢ ɬɚ ɞɨɩɨɜɧɟɧɧɹɦɢ).
Ⱦɚɬɚ ɡɚɩɨɜɧɟɧɧɹ ɪɨɡɪɚɯɭɧɤɭ (ɞɞ.ɦɦ.ɪɪɪɪ) ƒ ƒ
Ʉɟɪɿɜɧɢɤ ɩɿɞɩɪɢɽɦɫɬɜɚ
___________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
_______________
(ɩɿɞɩɢɫ)
Ɇ. ɉ.
Ƚɨɥɨɜɧɢɣ ɛɭɯɝɚɥɬɟɪ
___________________
(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)
_______________
(ɩɿɞɩɢɫ)
ɐɹ ɱɚɫɬɢɧɚ ɪɨɡɪɚɯɭɧɤɭ ɡɚɩɨɜɧɸɽɬɶɫɹ ɩɨɫɚɞɨɜɢɦɢ ɨɫɨɛɚɦɢ Ⱦɉȱ (ȾɉȺ)
ȼɿɞɦɿɬɤɚ ɩɪɨ ɜɧɟɫɟɧɧɹ ɞɚɧɢɯ ɞɨ ɟɥɟɤɬɪɨɧɧɨʀ ɛɚɡɢ ɩɨɞɚɬɤɨɜɨʀ ɡɜɿɬɧɨɫɬɿ "___" ____________ 200_ ɪ.
_________________________________________________________________________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))
Ɂɚ ɪɟɡɭɥɶɬɚɬɚɦɢ ɤɚɦɟɪɚɥɶɧɨʀ ɩɟɪɟɜɿɪɤɢ ɪɨɡɪɚɯɭɧɤɭ (ɩɨɬɪɿɛɧɟ ɩɨɡɧɚɱɢɬɢ):
ɩɨɪɭɲɟɧɶ (ɩɨɦɢɥɨɤ) ɧɟ ɜɢɹɜɥɟɧɨ ɫɤɥɚɞɟɧɨ ɚɤɬ ɜɿɞ "___" ____________ 200_ ɪ. N __________
"___" ____________ 200_ ɪ. ___________________________________________________
(ɩɿɞɩɢɫ, ɩɪɿɡɜɢɳɟ ɩɨɫɚɞɨɜɨʀ ɨɫɨɛɢ Ⱦɉȱ (ȾɉȺ))