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{\fdbmajor\f31525\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbmajor\f31526\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhimajor\f31530\fbidi \froman\fcharset0\fprq2 Cambria;}
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{\fdbminor\f31560\fbidi \froman\fcharset0\fprq2 Times New Roman;}{\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
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{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}{\fbiminor\f31580\fbidi \froman\fcharset0\fprq2 Times New Roman;}
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\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10174706 Cz\'ea\'9c\'e6 I
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid2117583 1. Dane osoby ubiegaj\'b9cej si\'ea o ustalenie prawa do \'9c
wiadczenia wychowawczego, zwanej dalej \'84osob\'b9 ubiegaj\'b9c\'b9 si\'ea\'94.
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph55\trrh245\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw2\brdrcf1 
\clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4818\clcbpatraw17 \cellx4818\clvertalt\clbrdrt\brdrs\brdrw2\brdrcf1 \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr
\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth5105\clcbpatraw17 \cellx9923\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 \hich\f0 Imi\'ea\cell 
\hich\af0\dbch\af35\loch\f0 Nazwisko\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \trowd \irow0\irowband0\ltrrow
\ts11\trgaph55\trrh245\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw2\brdrcf1 \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb
\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4818\clcbpatraw17 \cellx4818\clvertalt\clbrdrt\brdrs\brdrw2\brdrcf1 \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth5105\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4818\clshdrawnil \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth5105\clshdrawnil \cellx9923
\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \cell 
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385 \trowd \irow1\irowband1\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl 
\clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4818\clshdrawnil \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth5105\clshdrawnil \cellx9923\row \ltrrow}\trowd \irow2\irowband2\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4818\clcbpatraw17 \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2409\clcbpatraw17 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\pard\plain \ltrpar
\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 Numer PESEL}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\hich\af0\dbch\af35\loch\f0 *}{\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\up6\insrsid14498385 \hich\af0\dbch\af35\loch\f0 )}{\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0  \cell }{\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 
\b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 Stan cywilny\cell \hich\af0\dbch\af35\loch\f0 Obywatelstwo\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \trowd \irow2\irowband2\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4818\clcbpatraw17 \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2409\clcbpatraw17 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow3\irowband3\ltrrow
\ts11\trgaph55\trrh298\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb
\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4818\clshdrawnil \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2409\clshdrawnil 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923\pard\plain \ltrpar
\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\trowd \irow3\irowband3\ltrrow\ts11\trgaph55\trrh298\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4818\clshdrawnil \cellx4818\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth2409\clshdrawnil \cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923\row \ltrrow
}\trowd \irow4\irowband4\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 
\clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth9923\clcbpatraw17 \cellx9923\pard\plain \ltrpar
\s16\qc \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 Miejsce zamieszkania \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14498385 \trowd \irow4\irowband4\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth9923\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow5\irowband5\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth7227\clcbpatraw17 \cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 \hich\f0 Miejscowo\'9c\'e6\cell 
\hich\af0\dbch\af35\loch\f0 Kod pocztowy\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \trowd \irow5\irowband5\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth7227\clcbpatraw17 \cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow6\irowband6\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth7227\clshdrawnil \cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923
\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\par \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \trowd \irow6\irowband6\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth7227\clshdrawnil \cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr
\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923\row \ltrrow}\trowd \irow7\irowband7\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth5420\clcbpatraw17 \cellx5420\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth1807\clcbpatraw17 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\pard\plain \ltrpar
\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 Ulica\cell \hich\af0\dbch\af35\loch\f0 Numer domu\cell 
\hich\af0\dbch\af35\loch\f0 Numer mieszkania\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \trowd \irow7\irowband7\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth5420\clcbpatraw17 \cellx5420\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth1807\clcbpatraw17 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2696\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow8\irowband8\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5420\clshdrawnil \cellx5420\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1807\clshdrawnil \cellx7227\clvertalt\clbrdrt
\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923\pard\plain \ltrpar
\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\trowd \irow8\irowband8\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 
\clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5420\clshdrawnil \cellx5420\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1807\clshdrawnil 
\cellx7227\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth2696\clshdrawnil \cellx9923\row \ltrrow}\trowd \irow9\irowband9\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 
\clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth3613\clcbpatraw17 \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth6310\clcbpatraw17 \cellx9923\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0\afs18 \ltrch\fcs0 \b\fs18\insrsid14498385 \hich\af0\dbch\af35\loch\f0 \hich\f0 Numer telefonu (nieobowi\'b9\loch\f0 zkowo)\cell 
\hich\af0\dbch\af35\loch\f0 Adres poczty elektronicznej \hich\f0 \endash \loch\f0 \hich\f0  e-mail (obowi\'b9\loch\f0 \hich\f0 zkowo w przypadku sk\'b3\loch\f0 \hich\f0 adania wniosku drog\'b9\loch\f0 \hich\f0  elektroniczn\'b9\loch\f0 \hich\f0 , z wyj
\'b9\loch\f0 \hich\f0 tkiem wniosku sk\'b3\loch\f0 \hich\f0 adanego przy u\'bf\loch\f0 yciu ePUAP)}{\rtlch\fcs1 \ab\ai\af0\afs18 \ltrch\fcs0 \b\i\fs18\insrsid14498385 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\trowd \irow9\irowband9\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 
\clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \clcbpat17\cltxlrtb\clftsWidth3\clwWidth3613\clcbpatraw17 \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth6310\clcbpatraw17 \cellx9923\row \ltrrow}\trowd \irow10\irowband10\ltrrow
\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth3613\clshdrawnil \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth6310\clshdrawnil \cellx9923\pard\plain \ltrpar
\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\trowd \irow10\irowband10\ltrrow\ts11\trgaph55\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3613\clshdrawnil \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw2\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth6310\clshdrawnil \cellx9923
\row \ltrrow}\trowd \irow11\irowband11\lastrow \ltrrow\ts11\trgaph55\trrh40\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl 
\clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3613\clshdrawnil \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth6310\clshdrawnil \cellx9923\pard\plain \ltrpar\s16\ql \li0\ri0\nowidctlpar\noline\intbl\wrapdefault\hyphpar0\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1045\langfe1045\kerning1\loch\af0\hich\af0\dbch\af35\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385 
\trowd \irow11\irowband11\lastrow \ltrrow\ts11\trgaph55\trrh40\trleft0\trftsWidth1\trftsWidthB3\trpaddl55\trpaddt55\trpaddb55\trpaddr55\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind55\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3613\clshdrawnil \cellx3613\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw2\brdrcf1 \clbrdrb\brdrs\brdrw2\brdrcf1 \clbrdrr\brdrs\brdrw2\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth6310\clshdrawnil \cellx9923\row }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx462\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385 
\par }\pard \ltrpar\qj \fi-476\li476\ri0\nowidctlpar\tx462\wrapdefault\faauto\rin0\lin476\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\loch\af0\hich\af0\dbch\af37\insrsid14498385\charrsid16070783 \hich\af0\dbch\af37\loch\f0 )\tab \hich\f0 W przypadku, gdy nie nadano numeru PESEL, nale\'bf\loch\f0 \hich\f0 y poda\'e6\loch\f0 \hich\f0  numer i seri\'ea\loch\f0  dokumentu 
\hich\af0\dbch\af37\loch\f0 \hich\f0 potwierdzaj\'b9\loch\f0 \hich\f0 cego to\'bf\loch\f0 \hich\f0 samo\'9c\'e6.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 
\par }\pard \ltrpar\qj \fi-462\li462\ri0\nowidctlpar\tx462\wrapdefault\faauto\rin0\lin462\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385 
\par 
\par 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid9713193 2.  Ustalenie prawa do \'9cwiadczenia wychowawczego na pierwsze dziecko.
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9713193 
\par }\pard\plain \ltrpar\s17\qj \fi510\li0\ri0\widctlpar\wrapdefault\hyphpar0\faauto\rin0\lin0\itap0\pararsid14498385 \rtlch\fcs1 \ab\af1\afs20\alang1025 \ltrch\fcs0 \f40\fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\insrsid14498385\charrsid9713193 \'8cwiadczenie wychowawcze przys\'b3uguje na pierwsze dziecko je\'bfeli doch\'f3d rodziny \line w przeliczeniu na osob\'ea }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 
nie przekracza kwoty 800,00 z\'b3.}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193  Je\'bfeli cz\'b3onkiem rodziny jest dziecko niepe\'b3nosprawne, \'9cwiadczenie wychowawcze na pierwsze dziecko przys\'b3uguje je\'bfeli doch\'f3
d rodziny w przeliczeniu na osob\'ea }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 nie przekracza kwoty 1 200,00 z\'b3. }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 
\par Pierwsze dziecko}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193  oznacza }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 jedyne lub najstarsze dziecko w rodzinie w wieku do uko\'f1czenia 18. roku \'bf
ycia;}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193  w przypadku dzieci urodzonych tego samego dnia, miesi\'b9ca i roku, b\'ead\'b9cych najstarszymi dzie\'e6mi w rodzinie w wieku do uko\'f1czenia 18. roku \'bfycia \line (}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 czyli w przypadku wieloraczk\'f3w}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193 ) pierwsze dziecko }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid9713193 oznacza jedno z tych dzieci wskazane przez osob\'ea ubiegaj\'b9c\'b9 si\'ea.
\par Niepe\'b3nosprawne dziecko}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193  oznacza dziecko legitymuj\'b9ce si\'ea }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9713193 orzeczeniem o niepe\'b3nosprawno\'9cci}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193  okre\'9clonym w przepisach o rehabilitacji zawodowej i spo\'b3ecznej oraz zatrudnianiu os\'f3b niepe\'b3nosprawnych albo }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid9713193 orzeczeniem o umiarkowanym lub znacznym stopniu niepe\'b3nosprawno\'9cci}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\insrsid14498385\charrsid9713193 .
\par }\pard\plain \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid9713193   \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 W}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9713193 nosz\'ea }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid9713193 o ustalenie prawa do \'9cwiadczenia wychowawczego na pierwsze dziecko }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 zamieszkuj\'b9ce ze mn\'b9 oraz }{\rtlch\fcs1 \ab\af0\afs24 
\ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 pozostaj\'b9ce na moim utrzymaniu }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid9713193 (w przypadku zaznaczenia \endash  wype\'b3ni\'e6 tabel\'ea A oraz}{\rtlch\fcs1 
\ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385  tabel\'ea B w przypadku ubiegania si\'ea o \'9cwiadczenie wychowawcze r\'f3wnie\'bf na kolejne dzieci}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9713193 ).}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193   \u9633\'3f  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 N}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9713193 ie wnosz\'ea}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193   }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 
o ustalenie prawa do \'9cwiadczenia wychowawczego na pierwsze dziecko }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 zamieszkuj\'b9ce ze mn\'b9 oraz  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid9713193 pozostaj\'b9ce na moim utrzymaniu }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid9713193 (w przypadku zaznaczenia \endash  wype\'b3ni\'e6 tabel\'ea B}{\rtlch\fcs1 \ab\af0\afs24 
\ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9713193 ).}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid9713193 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 A}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10180243 . Pierwsze dziecko}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 . }{\rtlch\fcs1 
\ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10180243 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph70\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4181\clcbpatraw17 \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb
\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth3827\clcbpatraw17 \cellx7938\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth1560\clcbpatraw17 \cellx9498\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566  Imi\'ea \cell   Nazwisko\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e
\'e6}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow0\irowband0\ltrrow
\ts11\trgaph70\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4181\clcbpatraw17 \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth3827\clcbpatraw17 \cellx7938\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth1560\clcbpatraw17 \cellx9498\row \ltrrow
}\trowd \irow1\irowband1\ltrrow\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1
\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4181\clshdrawnil \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3827\clshdrawnil \cellx7938\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1560\clshdrawnil 
\cellx9498\pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  
\par \cell  
\par \cell }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid13191319 \u9633\'3f kobieta 
\par \u9633\'3f m\'ea\'bfczyzna}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow1\irowband1\ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4181\clshdrawnil \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3827\clshdrawnil \cellx7938\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1560\clshdrawnil \cellx9498\row \ltrrow
}\trowd \irow2\irowband2\ltrrow\ts11\trgaph70\trrh511\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1
\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2374\clcbpatraw17 \cellx2304\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth1807\clcbpatraw17 \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\clcbpat17\cltxlrtb\clftsWidth3\clwWidth2977\clcbpatraw17 \cellx7088\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2410\clcbpatraw17 \cellx9498
\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 )
\par 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow2\irowband2\ltrrow
\ts11\trgaph70\trrh511\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2374\clcbpatraw17 \cellx2304\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth1807\clcbpatraw17 \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2977\clcbpatraw17 \cellx7088
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2410\clcbpatraw17 \cellx9498\row \ltrrow}\trowd \irow3\irowband3\lastrow \ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2374\clshdrawnil \cellx2304\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1807\clshdrawnil \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2977\clshdrawnil \cellx7088\clvertalt\clbrdrt\brdrs\brdrw15 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil \cellx9498\pard\plain \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell \cell \cell }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow3\irowband3\lastrow \ltrrow\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth9568\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1
\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2374\clshdrawnil \cellx2304\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1807\clshdrawnil \cellx4111\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2977\clshdrawnil 
\cellx7088\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2410\clshdrawnil \cellx9498\row }\pard \ltrpar\qj \fi-476\li476\ri0\nowidctlpar
\tx476\wrapdefault\faauto\rin0\lin476\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 ) }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\loch\af0\hich\af0\dbch\af37\insrsid14498385\charrsid16070783 \hich\af0\dbch\af37\loch\f0 \hich\f0 W przypadku, gdy nie nadano numeru PESEL, nale\'bf\loch\f0 \hich\f0 y poda\'e6\loch\f0 \hich\f0  numer i seri\'ea\loch\f0  dokumentu 
\hich\af0\dbch\af37\loch\f0 \hich\f0 potwierdzaj\'b9\loch\f0 \hich\f0 cego to\'bf\loch\f0 \hich\f0 samo\'9c\'e6.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid4804750 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par Osoba ubiegaj\'b9ca si\'ea o \'9cwiadczenie wychowawcze na pierwsze dziecko do\'b3\'b9cza do wniosku odpowiednie za\'b3\'b9czniki (o\'9cwiadczenia) dotycz\'b9ce osi\'b9gni\'eatych dochod\'f3w wype\'b3nione przez cz\'b3onk\'f3w rodziny. 
\par 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid2117583 3. Ustalenie prawa do \'9cwiadczenia wychowawczego na }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385  kolejne dziecko/dzieci w wieku poni\'bfej
\line 18. roku \'bfycia, inne ni\'bf pierwsze dziecko}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid2117583 .}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid2117583 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid14448956 Wnosz\'ea o ustalenie prawa do \'9cwiadczenia wychowawczego na nast\'eapuj\'b9ce }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 dzieci/}{\rtlch\fcs1 
\ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid14448956 dziecko }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 zamieszkuj\'b9ce ze mn\'b9 oraz}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid14448956  
}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid14448956 pozostaj\'b9ce na moim utrzymaniu}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385  (}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385 \'9c}
{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid4220102 wiadczenie wychowawcze na drugie i kolejne dziecko przys\'b3uguje }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid4220102 do dnia uko\'f1
czenia przez dziecko 18}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385 .}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid4220102  roku \'bfycia}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385\charrsid4220102  i przys\'b3uguje niezale\'bfnie od osi\'b9gni\'eatego dochodu)}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385 :
\par 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par B}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16661255 . Kolejne }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 dziecko/dzieci }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\i\f0\fs24\insrsid14498385\charrsid13177105 (poni\'bfsza lista nie obejmuje pierwszego dziecka).}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385 
\par 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph70\trrh271\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9841114 1.\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Imi\'ea\cell  Nazwisko \cell }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e\'e6}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow0\irowband0\ltrrow\ts11\trgaph70\trrh271\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3195\clshdrawnil \cellx3125\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4534\clshdrawnil \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2057\clshdrawnil \cellx9716\pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  
\par \cell  \cell }\pard\plain \ltrpar\s19\ql \li0\ri0\widctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\cf1\lang1045\langfe1033\loch\af0\hich\af0\dbch\af37\cgrid\langnp1045\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid5194222 \loch\af0\dbch\af37\hich\f0 \u9633\'3f}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid14498385\charrsid5194222 \hich\af0\dbch\af37\loch\f0  kobieta 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid5194222 \loch\af0\dbch\af37\hich\f0 \u9633\'3f}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid14498385\charrsid5194222 \hich\af0\dbch\af37\loch\f0 \hich\f0  m\'ea\'bf\loch\f0 czyzna}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid14498385\charrsid5194222 \hich\af0\dbch\af37\loch\f0  \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow1\irowband1\ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3195\clshdrawnil \cellx3125\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4534\clshdrawnil \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2057\clshdrawnil \cellx9716\row \ltrrow}\trowd \irow2\irowband2\ltrrow
\ts11\trgaph70\trrh400\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid2120850 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow2\irowband2\ltrrow
\ts11\trgaph70\trrh400\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trgaph70\trrh633\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2153\clshdrawnil \cellx2083\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2387\clshdrawnil \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2841\clshdrawnil \cellx9716\pard\plain \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell \cell \cell }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14498385\charrsid10174706 \trowd \irow3\irowband3\ltrrow
\ts11\trgaph70\trrh633\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2153\clshdrawnil \cellx2083\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2387\clshdrawnil \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2841\clshdrawnil \cellx9716\row \ltrrow
}\trowd \irow4\irowband4\ltrrow\ts11\trgaph70\trrh320\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9841114 2.\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid12923566 Imi\'ea\cell Nazwisk}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 o}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e\'e6}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow4\irowband4\ltrrow
\ts11\trgaph70\trrh320\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trgaph70\trrh361\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\pard\plain \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 \cell }{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid14298258 \u9633\'3f}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid14498385\charrsid14298258  kobieta 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid14298258 \u9633\'3f }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid14498385\charrsid14298258 m\'ea\'bfczyzna}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow5\irowband5\ltrrow
\ts11\trgaph70\trrh361\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\row \ltrrow}\trowd \irow6\irowband6\ltrrow
\ts11\trgaph70\trrh413\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid2120850 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow6\irowband6\ltrrow
\ts11\trgaph70\trrh413\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts11\trgaph70\trrh592\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2153\clshdrawnil \cellx2083\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2387\clshdrawnil \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2841\clshdrawnil \cellx9716\pard\plain \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell \cell \cell  
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow7\irowband7\ltrrow
\ts11\trgaph70\trrh592\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2153\clshdrawnil \cellx2083\clvertalt
\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2387\clshdrawnil \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2841\clshdrawnil \cellx9716\row \ltrrow
}\trowd \irow8\irowband8\ltrrow\ts11\trgaph70\trrh315\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9841114 3.\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Imi\'ea}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid12923566 \cell Nazwisko\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e\'e6}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow8\irowband8\ltrrow\ts11\trgaph70\trrh315\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow9\irowband9\ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3195\clshdrawnil \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4534\clshdrawnil \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2057\clshdrawnil \cellx9716\clvertalt\clbrdrt
\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx12121\pard\plain \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell \cell }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid13191319 \u9633\'3f kobieta 
\par \u9633\'3f m\'ea\'bfczyzna}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 \cell }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow9\irowband9\ltrrow\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3195\clshdrawnil \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4534\clshdrawnil \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2057\clshdrawnil \cellx9716\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2405\clshdrawnil \cellx12121\row \ltrrow}\trowd \irow10\irowband10\ltrrow
\ts11\trgaph70\trrh465\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid3438307 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow10\irowband10\ltrrow
\ts11\trgaph70\trrh465\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow11\irowband11\ltrrow
\ts11\trgaph70\trrh412\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716
\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow11\irowband11\ltrrow
\ts11\trgaph70\trrh412\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716\row 
\ltrrow}\trowd \irow12\irowband12\ltrrow\ts11\trgaph70\trrh302\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9841114 4. \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Imi\'ea}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid12923566 \cell Nazwisko\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e\'e6}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow12\irowband12\ltrrow\ts11\trgaph70\trrh302\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth560\clcbpatraw17 \cellx490
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2635\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow13\irowband13\ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\pard\plain \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid13191319 \u9633\'3f kobieta 

\par \u9633\'3f m\'ea\'bfczyzna}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow13\irowband13\ltrrow
\ts11\trgaph70\trrh699\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\row \ltrrow}\trowd \irow14\irowband14\ltrrow
\ts11\trgaph70\trrh382\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid4220102 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow14\irowband14\ltrrow
\ts11\trgaph70\trrh382\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow15\irowband15\ltrrow
\ts11\trgaph70\trrh472\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716
\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14498385\charrsid10174706 \trowd \irow15\irowband15\ltrrow
\ts11\trgaph70\trrh472\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716\row 
\ltrrow}\trowd \irow16\irowband16\ltrrow\ts11\trgaph70\trrh317\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth534\clcbpatraw17 \cellx464
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2661\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid9841114 5.\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Imi\'ea}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid12923566 \cell Nazwisko\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 P\'b3e\'e6}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 
\trowd \irow16\irowband16\ltrrow\ts11\trgaph70\trrh317\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth534\clcbpatraw17 \cellx464
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2661\clcbpatraw17 \cellx3125\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw17 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow17\irowband17\ltrrow
\ts11\trgaph70\trrh438\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\pard\plain \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 
\par \cell }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid13191319 
\u9633\'3f kobieta 
\par \u9633\'3f m\'ea\'bfczyzna}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow17\irowband17\ltrrow
\ts11\trgaph70\trrh438\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3195\clcbpatraw8 \cellx3125
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4534\clcbpatraw8 \cellx7659\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2057\clcbpatraw8 \cellx9716\row \ltrrow}\trowd \irow18\irowband18\ltrrow
\ts11\trgaph70\trrh447\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\pard\plain \ltrpar\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 Numer PESEL}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 *}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\b\fs16\up6\insrsid14498385\charrsid2117583 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 Stan cywilny\cell Obywatelstwo\cell }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 Data}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385  urodzenia
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\i\f0\insrsid14498385\charrsid12923566 dd-mm-rrrr}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid4220102 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow18\irowband18\ltrrow
\ts11\trgaph70\trrh447\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw17 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw17 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 
\clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw17 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat17\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw17 
\cellx9716\row \ltrrow}\trowd \irow19\irowband19\lastrow \ltrrow
\ts11\trgaph70\trrh403\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716
\pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385 \cell }\pard \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\pvpara\phmrg\posnegx-145\posnegy-15\dxfrtext141\dfrmtxtx141\dfrmtxty0\wraparound\faauto\rin0\lin0\absnoovrlp1\pararsid7157156 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid9140581 \cell \cell }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \b\f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid12923566 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid10174706 \trowd \irow19\irowband19\lastrow \ltrrow
\ts11\trgaph70\trrh403\trleft-70\tpvpara\tphmrg\tposnegx-145\tposnegy-15\tdfrmtxtLeft141\tdfrmtxtRight141\trftsWidth3\trwWidth12191\trftsWidthB3\trftsWidthA3\trwWidthA2405\trpaddl70\trpaddr70\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2153\clcbpatraw8 \cellx2083
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2387\clcbpatraw8 \cellx4470\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2405\clcbpatraw8 \cellx6875\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2841\clcbpatraw8 \cellx9716\row 
}\pard \ltrpar\qj \fi-476\li476\ri0\nowidctlpar\tx476\wrapdefault\faauto\rin0\lin476\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 )  }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 W przypadku, gdy nie nadano numeru PESEL, nale\'bfy poda\'e6 numer i seri\'ea dokumentu potwierdzaj\'b9cego to\'bfsamo\'9c\'e6.
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par 
\par 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 4. }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid11021199 Dane cz\'b3onk\'f3w rodziny}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid11021199  
\par Rodzina oznacza odpowiednio: ma\'b3\'bfonk\'f3w, rodzic\'f3w dzieci, opiekuna faktycznego dziecka }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid11021199 (opiekun faktyczny dziecka to osoba faktycznie opiekuj\'b9c\'b9 si\'ea
 dzieckiem, je\'bfeli wyst\'b9pi\'b3a z wnioskiem do s\'b9du opieku\'f1czego o przysposobienie dziecka)}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  oraz zamieszkuj\'b9ce wsp\'f3lnie z tymi osobami, pozostaj\'b9
ce na ich utrzymaniu dzieci w wieku do uko\'f1czenia 25. roku \'bfycia, a tak\'bfe dzieci, kt\'f3re}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid11021199 uko\'f1czy\'b3y 25}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 .}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  rok \'bfycia, legitymuj\'b9ce si\'ea
 orzeczeniem o znacznym stopniu}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 niepe\'b3nosprawno\'9cci, je\'bfeli w zwi\'b9zku z t\'b9
 niepe\'b3nosprawno\'9cci\'b9 przys\'b3uguje \'9cwiadczenie}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 piel\'ea
gnacyjne lub specjalny zasi\'b3ek opieku\'f1czy albo zasi\'b3ek dla opiekuna, o kt\'f3rym mowa  w ustawie z dnia 4 kwietnia 2014 r. o ustaleniu i wyp\'b3acie zasi\'b3k\'f3w dla opiekun\'f3w (Dz. U. }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385 z 2016 r. poz. 162}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 ). Do cz\'b3onk\'f3w rodziny nie zalicza si\'ea dziecka}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid11021199  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 pozostaj\'b9cego pod opiek\'b9 opiekuna prawnego, dziecka pozostaj\'b9cego w zwi\'b9zku ma\'b3\'bfe\'f1skim,}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid11021199  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 a tak\'bfe pe\'b3noletniego dziecka posiadaj\'b9cego w\'b3asne dziecko. 
\par W przypadku gdy dziecko, zgodnie z orzeczeniem s\'b9du, jest pod opiek\'b9 naprzemienn\'b9 obydwojga rodzic\'f3w rozwiedzionych, \'bfyj\'b9cych w separacji lub \'bfyj\'b9cych w roz\'b3\'b9czeniu, dziecko zalicza si\'ea jednocze\'9cnie do cz\'b3onk\'f3
w rodzin obydwojga rodzic\'f3w.
\par Osoba samotnie wychowuj\'b9ca dziecko }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid11021199 (}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid11021199 oznacza to pann\'ea, kawalera, wdow\'ea, wdowca, osob
\'ea pozostaj\'b9c\'b9 w separacji orzeczonej prawomocnym wyrokiem s\'b9du, osob\'ea rozwiedzion\'b9, chyba \'bfe wychowuje wsp\'f3lnie co najmniej jedno dziecko z jego rodzicem}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid11021199 )}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199  nie wpisuje do sk\'b3adu rodziny drugiego z rodzic\'f3w dziecka.
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 W sk\'b3ad mojej rodziny zgodnie z ww. definicj\'b9 wchodz\'b9 }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid11021199 (zgodnie z ww. definicj
\'b9 nale\'bfy wpisa\'e6 wszystkich cz\'b3onk\'f3w rodziny osoby ubiegaj\'b9cej si\'ea o \'9cwiadczenie wychowawcze, w tym dzieci wskazane w tabeli A i B)}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid11021199 :
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 1.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 \tab urz\'b9d skarbowy}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
2.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 3......................................
.................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 

\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 4.............................................................................
..........................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
5.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 6}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
...................................................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 7}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko\tab stopie\'f1 pokrewie\'f1stwa\tab PESEL}{
\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 urz\'b9d skarbowy}{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\super\insrsid14498385\charrsid9794331 **}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid10174706 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \fi-378\li378\ri0\nowidctlpar\tx378\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\loch\af0\hich\af0\dbch\af37\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \loch\af0\hich\af0\dbch\af37\insrsid14498385\charrsid16070783 \hich\af0\dbch\af37\loch\f0 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16070783    W przypadku, gdy nie nadano numeru PESEL, nale\'bfy poda\'e6 numer }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 i seri\'ea }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 
dokumentu potwierdzaj\'b9cego to\'bfsamo\'9c\'e6.
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx378\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \loch\af0\hich\af0\dbch\af37\insrsid14498385\charrsid16070783 \hich\af0\dbch\af37\loch\f0 **}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\super\insrsid14498385\charrsid16070783 )   }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 Wype\'b3ni\'e6 tylko }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 w przypadku ubiegania si\'ea o \'9c
wiadczenie wychowawcze na pierwsze dziecko.}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid7094449\charrsid16070783 
\par }\pard \ltrpar\qj \fi-378\li378\ri0\nowidctlpar\tx378\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid7488507 5. O\'9cwiadczam, \'bfe orzeczeniem o niepe\'b3nosprawno\'9c
ci  lub orzeczeniem o umiarkowanym lub znacznym stopniu niepe\'b3nosprawno\'9cci legitymuje si\'ea nast\'eapuj\'b9ce dziecko wchodz\'b9ce w sk\'b3ad rodziny }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid7488507 (}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid7488507 wype\'b3ni\'e6 tylko }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid7488507 w przypadku ubiegania si\'ea o \'9cwiadczenie wychowawcze na pierwsze dziecko je\'9c
li cz\'b3onkiem rodziny jest dziecko legitymuj\'b9ce si\'ea ww. orzeczeniem}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid11021199 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid11021199 :}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid7488507 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 1.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385  
dziecka)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 
2.......................................................................................................................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid7094449 ..............................}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li378\ri0\nowidctlpar\tx2786\tx5949\tx7251\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 (imi\'ea i nazwisko}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
 dziecka)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 \tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385 
\par }\pard \ltrpar\qj \fi-378\li378\ri0\nowidctlpar\tx378\wrapdefault\faauto\rin0\lin378\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 6}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10174706 .}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10174706 Organ, do kt\'f3rego s\'b9 op\'b3acane sk\'b3adki na ubezpieczenie zdrowotne, o kt\'f3rych mowa \line 
w art. 3 pkt 1 lit. a ustawy z dnia 28 listopada 2003 r. o \'9cwiadczeniach rodzinnych }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 \line }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10174706 
(Dz. U. z 2015 r. poz. 114, z p\'f3\'9fn. zm.)}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 (}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid10444141 
wype\'b3ni\'e6 }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385 tylko }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid10444141 w przypadku ubiegania si\'ea o \'9cwiadczenie wychowawcze na pierwsze dziecko}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid8091136 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8091136 :}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid10174706  }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid7488507 
\par }{\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  Zak\'b3ad Ubezpiecze\'f1 Spo\'b3ecznych}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385                        \tab }{\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  Kasa Rolniczego Ubezpieczenia Spo
\'b3ecznego
\par }\pard \ltrpar\qj \fi-4950\li4956\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin4956\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706  Wojskowe Biuro Emerytalne}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385    \tab }{\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  Zak\'b3ad Emerytalno-Rentowy Ministerstwa }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par }\pard \ltrpar\qj \fi997\li4248\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin4248\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 Spraw Wewn\'eatrznych}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385 \tab \tab \tab 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706  Biuro Emerytalne S\'b3u\'bfby Wi\'eaziennej
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385  }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 Jednostka organizacyjna wymiaru sprawiedliwo\'9cci}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706  
\par }\pard \ltrpar\ql \fi421\li5951\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin5951\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\super\insrsid14498385\charrsid7683635 (nazwa i adres w\'b3a\'9cciwej jednostki)
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs36 \ltrch\fcs0 \f0\fs36\insrsid14498385\charrsid2368593 \u9633\'3f}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385  }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid10174706 inne}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385  \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10174706 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.\'85\'85\'85..
\par }\pard \ltrpar\ql \li3119\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin3119\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\super\insrsid14498385\charrsid7683635 (nazwa i adres w\'b3a\'9cciwej jednostki)}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \f0\fs22\super\insrsid14498385 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813 7. Inne dane}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid5137813  (}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 wype\'b3ni\'e6 tylko }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 w przypadku ubiegania si\'ea
 o \'9cwiadczenie wychowawcze na pierwsze dziecko}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid5137813 )}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813 :
\par 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx708\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 7.1.\tab \'a3\'b9czna kwota aliment\'f3w \'9cwiadczonych na rzecz innych os\'f3
b spoza rodziny wynios\'b3a w roku .........}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid5137813  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 *}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\super\insrsid14498385\charrsid5137813 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 .......... z\'b3 ..... gr.
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 7.2 W roku kalendarzowym* poprzedzaj\'b9cym okres}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid5137813  na kt\'f3ry jest ustalane prawo do \'9cwiadczenia wychowawczego}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813  cz\'b3
onkowie rodziny osi\'b9gn\'eali dochody:
\par \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813  niepodlegaj\'b9ce opodatkowaniu podatkiem dochodowym od os\'f3b fizycznych}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 
 na zasadach okre\'9clonych w art. }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid14248005 27, art. 30b,  art. 30c, art. 30e i art. 30f ustawy z dnia 26 lipca 1991 r. o podatku dochodowym od os\'f3
b fizycznych (Dz. U. z 2012 r. poz. 361, z p\'f3\'9fn. zm.) \endash  wskazane w pouczeniu do Za\'b3\'b9cznika nr 2 }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid14248005 (}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385\charrsid14248005 w przypadku zaznaczenia}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid14248005  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid14248005 dodatkowo nale\'bf
y do\'b3\'b9czy\'e6}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813  wype\'b3nione o\'9cwiadczenie cz\'b3onka/cz\'b3onk\'f3w  rodziny  stanowi\'b9ce  Za\'b3\'b9cznik nr 2 do wniosku )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 \u9633\'3f }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813 z dzia\'b3alno\'9cci podlegaj\'b9cej opodatkowaniu na podstawie przepis\'f3
w o zrycza\'b3towanym podatku dochodowym od niekt\'f3rych przychod\'f3w osi\'b9ganych przez osoby fizyczne }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 (rycza\'b3t ewidencjonowany lub karta podatkowa)}{\rtlch\fcs1 
\ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid6644970 ,}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 pomniejszony o nale
\'bfny zrycza\'b3towany podatek dochodowy \line i sk\'b3adki na ubezpieczenia spo\'b3eczne i zdrowotne}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385\charrsid5137813 (}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 w przypadku zaznaczenia}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid5137813  }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 dodatkowo nale\'bfy do\'b3\'b9czy\'e6 wype\'b3nione o\'9cwiadczenie cz\'b3onka/cz\'b3onk\'f3w  rodziny  stanowi\'b9ce  Za\'b3\'b9cznik nr 3 do wniosku)}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5137813 \u9633\'3f }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid5137813 uzyskane z gospodarstwa rolnego, }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid10714758 (}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 w przypadku zaznaczenia}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid5137813  }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 dodatkowo nale\'bfy do\'b3\'b9czy\'e6 o\'9cwiadczenie cz\'b3onka/cz\'b3onk\'f3w  rodziny  stanowi\'b9ce wype\'b3nione Za\'b3\'b9cznik nr 3 lub Za\'b3\'b9cznik nr 4 \line do wniosku)}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385 .
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid5137813 
\par }\pard \ltrpar\qj \fi-360\li360\ri0\nowidctlpar\tx360\wrapdefault\faauto\rin0\lin360\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 )}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab Wpisa\'e6 rok kalendarzowy, z kt\'f3rego doch\'f3d stanowi podstaw\'ea ustalenia dochodu rodziny\line (w przypadku ubiegania si\'ea o \'9cwiadczenie wychowawcze na okres trwaj\'b9
cy od 1 kwietn}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 i}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 a 2016 r.\line do 30 wrze\'9cnia 2017 r., nale\'bfy wpisa\'e6 rok 2014).
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid13044034 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx708\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 Ponadto dochodem rodziny osoby ubiegaj\'b9cej si\'ea o \'9cwiadczenie wychowawcze na pierwsze dziecko s\'b9 przychody podlegaj\'b9ce opodatkowaniu na zasadach okre\'9c
lonych w art. 27, art. 30b, art. 30c, art. 30e i art. 30f ustawy z dnia 26 lipca 1991 r. o podatku dochodowym od os\'f3b fizycznych, pomniejszone o koszty uzyskania przychodu, nale\'bfny podatek dochodowy od os\'f3b fizycznych, sk\'b3
adki na ubezpieczenia spo\'b3eczne niezaliczone do koszt\'f3w uzyskania przychodu oraz sk\'b3adki na ubezpieczenie zdrowotne \endash  }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid16070783 dane o tych dochodach o
rgan uzyskuje samodzielnie.}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 7.3.\tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 Informacja na temat sytuacji zwi\'b9zanych z uzyskaniem lub utrat\'b9 dochodu }{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 (}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \i\f0\fs24\insrsid14498385\charrsid16070783 wype\'b3ni\'e6 tylko }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\i\f0\fs24\insrsid14498385\charrsid16070783 w przypadku ubiegania si\'ea o \'9cwiadczenie wychowawcze na pierwsze dziecko}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid16070783 )}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid16070783 :}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 
\par W roku kalendarzowym poprzedzaj\'b9cym okres}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783  na kt\'f3ry jest ustalane prawo do \'9cwiadczenia wychowawczego}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783   lub po tym roku:
\par \u9633\'3f }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 nast\'b9pi\'b3a utrata przez cz\'b3onka rodziny dochodu}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 **}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid16070783 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid7616471 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 nie }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid16070783 nast\'b9pi\'b3a utrata przez cz\'b3onka rodziny dochodu}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 .}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 

\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 W roku kalendarzowym  poprzedzaj\'b9cym okres}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid16070783  na kt\'f3ry jest ustalane prawo do \'9cwiadczenia wychowawczego}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 
  lub po tym roku:
\par \u9633\'3f }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 nast\'b9pi\'b3o uzyskanie przez cz\'b3onka rodziny dochodu}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 ***}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid16070783 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 ,}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid7952838 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid16070783 nie }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid16070783 nast\'b9pi\'b3o uzyskanie przez cz\'b3onka rodziny dochodu}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 .}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid16070783 

\par }\pard \ltrpar\qj \fi-360\li360\ri0\nowidctlpar\tx360\wrapdefault\faauto\rin0\lin360\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 **}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab 
Utrata dochodu, zgodnie z art. 2 pkt 19 ustawy z dnia 11 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu dzieci (Dz. U. poz}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 . 195}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 
), oznacza utrat\'ea dochodu spowodowan\'b9:
\par }\pard \ltrpar\qj \fi-426\li776\ri0\nowidctlpar\tx776\wrapdefault\faauto\rin0\lin776\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab uzyskaniem prawa do urlopu wychowawczego,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab utrat\'b9 prawa do zasi\'b3
ku lub stypendium dla bezrobotnych,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab utrat\'b9
 zatrudnienia lub innej pracy zarobkowej, 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab utrat\'b9 zasi\'b3ku przedemerytalnego lub 
\'9cwiadczenia przedemerytalnego, nauczycielskiego \'9cwiadczenia kompensacyjnego, a tak\'bfe emerytury lub renty, renty rodzinnej lub renty socjalnej, 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab wyrejestrowaniem pozarolniczej dzia\'b3alno
\'9cci gospodarczej lub zawieszeniem jej wykonywania w rozumieniu art. 14a ust. 1d ustawy z dnia 2 lipca 2004 r. o swobodzie dzia\'b3alno\'9cci gospodarczej (Dz. U. z 2015 r. poz. 584, z p\'f3\'9fn. zm.)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 ,
}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab utrat\'b9 zasi\'b3ku chorobowego, \'9c
wiadczenia rehabilitacyjnego lub zasi\'b3ku macierzy\'f1skiego, przys\'b3uguj\'b9cych po utracie zatrudnienia lub innej pracy zarobkowej,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab utrat\'b9 zas\'b9dzonych \'9cwiadcze\'f1
 alimentacyjnych w zwi\'b9zku ze \'9cmierci\'b9 osoby zobowi\'b9zanej do tych \'9cwiadcze\'f1 lub utrat\'b9 \'9cwiadcze\'f1 pieni\'ea\'bfnych wyp\'b3acanych w przypadku bezskuteczno\'9cci egzekucji aliment\'f3w w zwi\'b9zku ze \'9cmierci\'b9 osoby zobowi
\'b9zanej do \'9cwiadcze\'f1 alimentacyjnych,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16070783 utrat\'b9 \'9cwiadczenia rodzicielskiego,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af41 \ltrch\fcs0 \f41\insrsid14498385 \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16070783 utrat\'b9 zasi\'b3ku macierzy\'f1skiego, o kt\'f3rym mowa w przepisach o ubezpieczeniu spo\'b3ecznym rolnik\'f3w,
\par }\pard \ltrpar\qj \fi-709\li709\ri0\nowidctlpar\tx776\wrapdefault\faauto\rin0\lin709\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385        \endash \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 utrat\'b9
 stypendium doktoranckiego okre\'9clonego w art. 200 ust. 1 ustawy z dnia 27 lipca 2005 r. \endash  Prawo o szkolnictwie wy\'bfszym (Dz. U. z 2012 r. poz. 572, z p\'f3\'9fn. zm.).
\par }\pard \ltrpar\qj \fi-364\li364\ri0\nowidctlpar\tx364\wrapdefault\faauto\rin0\lin364\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 ***}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid16070783 )}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783  Uzyskanie dochodu, zgodnie z art. 2 pkt 20 ustawy z dnia 11 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu, oznacza uzyskanie dochodu spowodowane:
\par }\pard \ltrpar\qj \fi-364\li700\ri0\nowidctlpar\tx700\wrapdefault\faauto\rin0\lin700\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab zako\'f1czeniem urlopu wychowawczego,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab uzyskaniem prawa do zasi\'b3
ku lub stypendium dla bezrobotnych,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab 
uzyskaniem zatrudnienia lub innej pracy zarobkowej, 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab uzyskaniem zasi\'b3ku przedemerytalnego lub 
\'9cwiadczenia przedemerytalnego, nauczycielskiego \'9cwiadczenia kompensacyjnego, a tak\'bfe emerytury lub renty, renty rodzinnej lub renty socjalnej, 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab rozpocz\'eaciem pozarolniczej dzia\'b3alno\'9c
ci gospodarczej lub wznowieniem jej wykonywania po okresie zawieszenia w rozumieniu art. 14a ust. 1d ustawy z dnia 2 lipca 2004 r. o swobodzie dzia\'b3alno\'9cci gospodarczej,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 \tab uzyskaniem zasi\'b3ku chorobowego, \'9c
wiadczenia rehabilitacyjnego lub zasi\'b3ku macierzy\'f1skiego, przys\'b3uguj\'b9cych po utracie zatrudnienia lub innej pracy zarobkowej,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16070783 uzyskaniem \'9cwiadczenia rodzicielskiego,
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16070783 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16070783 uzyskaniem zasi\'b3ku macierzy\'f1skiego, o kt\'f3rym mowa w przepisach o ubezpieczeniu spo\'b3ecznym rolnik\'f3w,
\par \endash \tab uzyskaniem stypendium doktoranckiego okre\'9clonego w art. 200 ust. 1 ustawy z dnia 27 lipca 2005 r. \endash  Prawo o szkolnictwie wy\'bfszym.
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx700\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid10174706 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid4603636 Cz\'ea\'9c\'e6 II
\par }\pard \ltrpar\qj \fi-284\li284\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin284\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\ul\insrsid14498385\charrsid16725642 O\'9cwiadczenie dotycz\'b9ce ustalenia prawa do \'9c
wiadczenia wychowawczego na dziecko}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\ul\insrsid14498385\charrsid16725642 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 O\'9cwiadczam, \'bfe:
\par }\pard \ltrpar\qj \fi-284\li284\ri0\nowidctlpar\tx284\wrapdefault\faauto\rin0\lin284\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab powy\'bfsze dane s\'b9 prawdziwe,
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab zapozna\'b3am/zapozna\'b3
em si\'ea z warunkami uprawniaj\'b9cymi do \'9cwiadczenia wychowawczego,
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab na dziecko/dzieci, na kt
\'f3re ubiegam si\'ea o \'9cwiadczenie wychowawcze, nie jest pobierane \line w tej lub innej instytucji \'9cwiadczenie wychowawcze,
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab pe\'b3
noletnie dziecko/dzieci, na kt\'f3re ubiegam si\'ea o \'9cwiadczenie wychowawcze, nie jest/nie s\'b9 uprawnione do \'9cwiadczenia wychowawczego na w\'b3asne dziecko, 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab dziecko/dzieci, na kt\'f3
re ubiegam si\'ea o \'9cwiadczenie wychowawcze nie pozostaje/nie pozostaj\'b9 w zwi\'b9zku ma\'b3\'bfe\'f1skim ani nie zosta\'b3o/nie zosta\'b3y umieszczone w pieczy zast\'eapczej, instytucji zapewniaj\'b9cej ca\'b3odobowe utrzymanie, tj. domu pomocy spo
\'b3ecznej, m\'b3odzie\'bfowym o\'9crodku wychowawczym, schronisku dla nieletnich, zak\'b3adzie poprawczym, areszcie \'9cledczym, zak\'b3adzie karnym, a tak\'bfe szkole wojskowej lub innej szkole, je\'bfeli instytucje te zapewniaj\'b9 nieodp\'b3atne pe
\'b3ne utrzymanie,
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \tab cz\'b3
onkowi rodziny nie przys\'b3uguje na dziecko \'9cwiadczenie wychowawcze lub \'9cwiadczenie \line o charakterze podobnym do \'9cwiadczenia wychowawczego za granic\'b9 lub przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego lub dwustro
nne umowy }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 mi\'eadzynarodowe }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 o zabezpieczeniu spo\'b3ecznym stanowi\'b9, \'bfe przys\'b3uguj\'b9ce za granic\'b9 
\'9cwiadczenie nie wy\'b3\'b9cza prawa do takiego \'9cwiadczenia na podstawie ustawy,
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx708\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid2498482 nie przebywam}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  poza granicami Rzeczypospolitej Polskiej*}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  w pa\'f1stwie, w kt\'f3rym maj\'b9 zastosowanie przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego**}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 ,
\par \u9633\'3f }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 przebywam}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  poza granicami Rzeczypospolitej Polskiej*}{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  w pa\'f1stwie, w kt\'f3rym maj\'b9 zastosowanie przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego**}{
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 ,
\par \u9633\'3f cz\'b3onek mojej rodziny, w rozumieniu art. 2 pkt 16 ustawy z dnia 11 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu dzieci, }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 nie przebywa }{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 poza granicami Rzeczypospolitej Polskiej*}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid2498482  w pa\'f1stwie, w kt\'f3rym maj\'b9 zastosowanie przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego**}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 .
\par \u9633\'3f cz\'b3onek mojej rodziny, w rozumieniu art. 2 pkt 16 ustawy z dnia 11 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu dzieci,}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482  przebywa}{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  poza granicami Rzeczypospolitej Polskiej*}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid2498482  w pa\'f1stwie, w kt\'f3rym maj\'b9 zastosowanie przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego**}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 
\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 .}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 
\par }\pard \ltrpar\qj \fi-539\li539\ri0\nowidctlpar\tx540\wrapdefault\faauto\rin0\lin539\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 *}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 \tab 
Nie dotyczy wyjazdu lub pobytu turystycznego, leczniczego lub zwi\'b9zanego z podj\'eaciem przez dziecko kszta\'b3cenia poza granicami Rzeczypospolitej Polskiej.
\par **}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\super\insrsid14498385\charrsid2498482 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 \tab Przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego maj\'b9 zastosowanie na terenie: }{
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 Austrii, Belgii, Chorwacji, Danii, Finlandii, Francji, Grecji, Hiszpanii, Holandii, Irlandii, Luksemburga, Niemiec, Portugalii, Szwecji, W\'b3och, Wielkiej Brytanii,}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\insrsid14498385\charrsid2498482  }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cs15\f0\insrsid14498385\charrsid2498482 Cypru, Czech, Estonii, Litwy, \'a3otwy, Malty, Polski, S\'b3owacji, S\'b3owenii, W\'eagier, Bu\'b3garii, Rumunii}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 , }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid2498482 Norwegii, Islandii, Liechtensteinu, Szwajcarii.
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 W przypadku zmian maj\'b9cych wp\'b3yw na prawo do \'9cwiadczenia wychowawczego, \line w szczeg\'f3lno\'9cci}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid2498482  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 zaistnienia okoliczno\'9cci wymienionych w o\'9cwiadczeniu, uzyskania dochodu lub wyst\'b9pienia innych okoliczno\'9cci maj\'b9
cych wp\'b3yw na prawo do \'9cwiadczenia wychowawczego, w tym zwi\'b9zanych z konieczno\'9cci\'b9 ponownego ustalenia prawa do tego \'9cwiadczenia na podstawie art. 7 ust. 1-4 ustawy }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid2498482 z dnia 11 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu dzieci,}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482  osoba ubiegaj\'b9ca si\'ea}{\rtlch\fcs1 \af0\afs24 
\ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 jest obowi\'b9zana niezw\'b3ocznie powiadomi\'e6 o tych zmianach podmiot realizuj\'b9cy \'9cwiadczenie wychowawcze.

\par Niepoinformowanie organu w\'b3a\'9cciwego prowadz\'b9cego post\'eapowanie w sprawie \'9cwiadczenia wychowawczego o zmianach, o kt\'f3rych mowa powy\'bfej, mo\'bfe skutkowa\'e6 powstaniem nienale\'bfnie}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid2498482  }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482 pobranego \'9cwiadczenia wychowawczego, a w konsekwencji }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\f0\fs24\insrsid14498385\charrsid2498482 {\field{\*\fldinst SYMBOL 45 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid2498482  konieczno\'9cci\'b9
 jego zwrotu wraz z odsetkami ustawowymi za op\'f3\'9fnienie.
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\i\f0\fs24\insrsid14498385\charrsid2498482 Obowi\'b9zek informowania o zmianach w sytuacji dochodowej rodziny, w szczeg\'f3lno\'9cci uzyskania dochodu, dotyczy wy\'b3\'b9cznie os\'f3b ubiegaj\'b9cych si\'ea/otrzymuj
\'b9cych \'9cwiadczenie wychowawcze \line na pierwsze dziecko.
\par 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid2498482 Prosz\'ea o wp\'b3at\'ea \'9cwiadczenia wychowawczego na nast\'eapuj\'b9
cy nr rachunku bankowego 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid6622819 
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx250\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx608\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx966\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx1324
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx1682\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx2040\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx2397\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx2754\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx3111\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx3468\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx3825\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4182\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4539\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4896\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5253\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5610\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5967\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx6324\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx6681\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx7038\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx7395\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx7752\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8109\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8466\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8823\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx9180\pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {
\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid5194222 \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14498385 \trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx250\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx608\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx966\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx1324
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx1682\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx2040\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx2397\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx2754\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx3111\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx3468\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx3825\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4182\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4539\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx4896\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5253\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5610\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5967\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx6324\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx6681\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx7038\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx7395\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx7752\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8109\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8466\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx8823\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx9180\row }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385 
\par w banku\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid6622819 
\par }\pard \ltrpar\qj \fi421\li3827\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin3827\itap0\pararsid14498385 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\super\insrsid14498385\charrsid7683635 (n}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\f0\fs22\super\insrsid14498385 azwa banku}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\super\insrsid14498385\charrsid7683635 )}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid14498385 
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 Do wniosku do\'b3\'b9czam nast\'eapuj\'b9ce dokumenty (o\'9cwiadczenia s\'b9 tak\'bfe dokumentami):}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\pard\plain \ltrpar
\qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 1)

\par \cell  .........................
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385\charrsid7488507 \trowd \irow0\irowband0\ltrrow\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\row 
\ltrrow}\pard\plain \ltrpar\qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid7488507 2)
\par \cell  .........................
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385\charrsid7488507 \trowd \irow1\irowband1\ltrrow\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\row 
\ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trgaph70\trrh80\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone 
\clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\pard\plain \ltrpar
\qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 3)

\par \cell  .........................
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14498385\charrsid7488507 \trowd \irow2\irowband2\ltrrow\ts11\trgaph70\trrh80\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\row 
\ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\pard\plain \ltrpar
\qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 4)

\par \cell  .........................\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid7488507 \trowd \irow3\irowband3\ltrrow
\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\row \ltrrow}\pard\plain \ltrpar
\qj \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid7157156 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid7094449 
\par 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid7094449\charrsid7488507 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14498385\charrsid7488507 \trowd \irow4\irowband4\lastrow \ltrrow
\ts11\trgaph70\trleft-70\trftsWidth1\trftsWidthB3\trpaddl70\trpaddr70\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7157156\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth565\clshdrawnil \cellx495\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3465\clshdrawnil \cellx3960\row }\pard \ltrpar
\qc \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\f0\insrsid7094449 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\f0\insrsid14498385\charrsid16649399 Pouczenie}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 
\par }\pard\plain \ltrpar\s18\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14498385 \rtlch\fcs1 \ab\af1\afs20\alang1025 \ltrch\fcs0 \f40\fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\fs20\insrsid14498385\charrsid16649399 Na podstawie art. 4 ust. 2 ustawy z dnia }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\fs20\insrsid14498385 11 lutego 2016 r.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\fs20\insrsid14498385\charrsid16649399  o pomocy pa
\'f1stwa w wychow}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\fs20\insrsid14498385 ywaniu dzieci (Dz. U. poz. 195)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\fs20\insrsid14498385\charrsid16649399  \'9cwiadczenie wychowawcze przys\'b3
uguje: matce, ojcu, opiekunowi faktycznemu dziecka (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\f0\fs20\insrsid14498385\charrsid16649399 opiekun faktyczny dziecka to osoba faktycznie opiekuj\'b9c\'b9 si\'ea dzieckiem, je\'bfeli wyst\'b9pi\'b3a z wnioskiem do s\'b9
du opieku\'f1czego o przysposobienie dziecka}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\fs20\insrsid14498385\charrsid16649399 ) albo opiekunowi prawnemu dziecka.
\par }\pard\plain \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f39\fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\f0\insrsid14498385\charrsid16649399 \'8cwiadczenie wychowawcze}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399  przys\'b3uguje:
\par }\pard \ltrpar\qj \fi-284\li0\ri0\nowidctlpar\tx426\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 1)\tab obywatelom polskim,
\par 2)\tab cudzoziemcom:
\par }\pard \ltrpar\qj \fi-284\li0\ri0\nowidctlpar\tx710\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 a)\tab do kt\'f3rych stosuje si\'ea przepisy o koordynacji system\'f3
w zabezpieczenia spo\'b3ecznego,
\par b)\tab je\'bfeli wynika to z wi\'b9\'bf\'b9cych Rzeczpospolit\'b9 Polsk\'b9 dwustronnych um\'f3w mi\'eadzynarodowych o zabezpieczeniu spo\'b3ecznym,
\par c)\tab przebywaj\'b9cym na terytorium Rzeczypospolitej Polskiej na podstawie zezwolenia na pobyt czasowy udzielonego w zwi\'b9zku z okoliczno\'9cciami, o kt\'f3rych mowa w art. 127 ustawy z dnia 12 grudnia 2013 r. o cudzoziemcach (Dz. U. poz. 1650, z p
\'f3\'9fn. zm.), je\'bfeli zamieszkuj\'b9 z cz\'b3onkami rodzin na terytorium Rzeczypospolitej Polskiej,
\par d) posiadaj\'b9cym kart\'ea pobytu z adnotacj\'b9 \'84dost\'eap do rynku pracy\'94, je\'bfeli zamieszkuj\'b9 z cz\'b3onkami rodzin na terytorium Rzeczypospolitej Polskiej, z wy\'b3\'b9czeniem obywateli pa\'f1stw trzecich, kt\'f3
rzy uzyskali zezwolenie na prac\'ea na terytorium pa\'f1stwa cz\'b3onkowskiego na okres nieprzekraczaj\'b9cy sze\'9cciu miesi\'eacy, obywateli pa\'f1stw trzecich przyj\'eatych w celu podj\'eacia studi\'f3w oraz obywateli pa\'f1stw trzecich, kt\'f3rzy maj
\'b9 prawo do wykonywania pracy na podstawie wizy.
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 \'8cwiadczenie wychowawcze przys\'b3uguje do dnia uko\'f1czenia przez dziecko 18}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \f0\insrsid14498385 .}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399  roku \'bfycia (art. 4 ust. 3 ustawy}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid473018  }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16649399 z dnia }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 11 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid9583349 lutego 2016 r. o pomocy pa\'f1stwa w wychowywaniu dzieci).
\par Prawo do \'9cwiadczenia wychowawczego przys\'b3uguje osobom, o kt\'f3rych mowa w pkt 1 i 2, je\'bfeli zamieszkuj\'b9 na terytorium Rzeczypospolitej Polskiej przez okres, w kt\'f3rym maj\'b9 otrzymywa\'e6 \'9cwiadczenie wychowawcze, chyba \'bf
e przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego lub dwustronne umowy }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 mi\'eadzynarodowe }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid9583349 o zabezpieczeniu spo\'b3
ecznym stanowi\'b9 inaczej}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 .}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid9583349 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 \'8cwiadczenie wychowawcze nie przys\'b3uguje, je\'bfeli:
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\tx426\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 1)\tab dziecko pozostaje w zwi\'b9zku ma\'b3\'bfe\'f1skim (art. 8 pkt 1 ustawy}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid473018  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 z dnia }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 11 lutego 2016 r.}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385\charrsid16649399  o pomocy pa\'f1stwa w wychow}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 ywaniu dzieci}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 );
\par 2)\tab dziecko zosta\'b3o umieszczone w instytucji zapewniaj\'b9cej ca\'b3odobowe utrzymanie, tj. domu pomocy spo\'b3ecznej, schronisku dla nieletnich, m\'b3odzie\'bfowym o\'9crodku wychowawczym, zak\'b3adzie poprawczym, areszcie \'9cledczym, zak\'b3
adzie karnym, a tak\'bfe szkole wojskowej lub innej szkole, je\'bfeli instytucje te zapewniaj\'b9 nieodp\'b3atnie pe\'b3ne utrzymanie, albo w pieczy zast\'eapczej (art. 8 pkt 2 ustawy}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid473018  }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 z dnia }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 11 lutego 2016 r.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399  o pomocy pa\'f1stwa w wychow}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \f0\insrsid14498385 ywaniu dzieci}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 );
\par 3)\tab pe\'b3noletnie dziecko }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 ma ustalone prawo}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399  do \'9cwiadczenia wychowawczego na w\'b3asne dziecko (art. 8 pkt 3 ustawy).
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 \'8cwiadczenie wychowawcze nie przys\'b3uguje cz\'b3onkowi rodziny, je\'bfeli na dziecko przys
\'b3uguje \'9cwiadczenie wychowawcze lub \'9cwiadczenie o charakterze podobnym do \'9cwiadczenia wychowawczego za granic\'b9, chyba \'bfe przepisy o koordynacji system\'f3w zabezpieczenia spo\'b3ecznego lub dwustronne umowy }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid14498385 mi\'eadzynarodowe }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 o zabezpieczeniu spo\'b3ecznym stanowi\'b9 inaczej (art. 8 pkt 4 ustawy}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7826332  }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 z dnia }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 11 lutego 2016 r.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399  o pomocy pa\'f1stwa w wychow}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \f0\insrsid14498385 ywaniu dzieci}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 ).
\par }{\rtlch\fcs1 \ai\af0 \ltrch\fcs0 \b\f0\insrsid14498385 
\par }{\rtlch\fcs1 \ai\af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid14498385 
\par 
\par }{\rtlch\fcs1 \ai\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8274103 O\'9cwiadczam, \'bfe zapozna\'b3am/zapozna\'b3em si\'ea z powy\'bfszym pouczeniem.}{\rtlch\fcs1 \ai\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385\charrsid8274103 
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8274103 
\par }{\rtlch\fcs1 \ai\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8274103 O\'9cwiadczam, \'bfe jestem \'9cwiadomy/\'9cwiadoma odpowiedzialno\'9cci karnej za z\'b3o\'bfenie}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid14498385\charrsid8274103  }{\rtlch\fcs1 \ai\af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8274103 fa\'b3szywego o\'9cwiadczenia.
\par }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid14498385\charrsid8274103 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 
\par }\pard \ltrpar\qj \fi708\li1416\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin1416\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 
................................................................................................................
\par }\pard \ltrpar\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399      }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385                                      }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399     (miejscowo\'9c\'e6, data i podpis }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385 osoby ubiegaj\'b9cej si\'ea}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid16649399 )}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid14498385\charrsid7488507 
\par }\pard \ltrpar\qr \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14498385 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\f0\fs24\insrsid14498385 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par 
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12680584 
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