PREVIDNCIA SOCIAL

1 - NOME : ______________________________________________________________________
2 - ENDEREO : _________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
3 - PROFISSO : _________________________________________________________________
4 - DATA NASCIMENTO : ______________________________________________
5 - ESTADO CIVIL : _____________________________________________________
6 - C.P.F. : _______________________________ R.G. : __________________________________
7 - CTPS : ___________________________________________
8 - CONTRIBUINTE DO INSS : ( ) SIM
( ) NO
9 - NMERO DO NIT, PIS OU PASEP : ______________________________________________
10 - DEFICIENTE : ( ) SIM ( ) NO TIPO DE DEFICINCIA : ___________________
________________________________________________________________________________
11 - O QUE REQUEREU AO INSS : _________________________________________________
________________________________________________________________________________
12 - FEZ PERCIA ? ( ) SIM
( ) NO
13 - A PERCIA FOI DEFERIDA ?
( ) SIM
( ) NO
14 - VALOR TOTAL DO SALRIO DA FAMLIA : _____________________________________
15 - TEM FILHOS? ( ) SIM ( ) NO
QUANTOS ? (
)
16 TELEFONES : ( _____ ) ____________________ , ______________________
17 COM QUEM MORA? _________________________________________________________
OBSERVAES :
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
______________________________________________________________________________ .