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Permit for a residence of a long-term EU resident

Click on the document below to view instructions for the questions on the residence permit application form of long-term EU residents.

(miejsce i data złożenia wniosku) / (place and date of submission of the application) / (lieu et date du dépôt de la demande) / (место и дата составления заявки)

Leave this section empty, it`s to be filled out by the Migration Office. 

WNIOSEK O UDZIELENIE CUDZOZIEMCOWI ZEZWOLENIA NA POBYT REZYDENTA DŁUGOTERMINOWEGO UNII EUROPEJSKIEJ APPLICATION FOR THE RESIDENCE PERMIT FOR THE LONG-TERM RESIDENT OF THE EUROPEAN UNION LA DEMANDE D'AUTORISATION DE SÉJOUR DE RÉSIDENT DE LONGUE DURÉE DE L`UNION EUROPÉENNE ЗАЯВКА НА ПРЕДОСТАВЛЕНИИ ИНОСТРАНЦУ РАЗРЕШЕНИЯ НА ПРЕБЫВАНИЕ ДОЛГОСРОЧНОГО РЕЗИДЕНТА ЕВРОПЕЙСКОГО СОЮЗА find out more →

General remarks before you start filling out the application:

1. fill it out in capital letters

2. fill it out in Polish

3. If you are not answering any question, put a long line "---" or enter: nie dotyczy (not applicable)

Do / to / à / для (nazwa organu, do którego jest składany wniosek) / (name of the authority the application is submitted to) / (dénomination de l’autorité aupres de laquelle demande est déposée) / (название органа для которого составляется заявка)

Enter a name of the Voivode which you address your application to.  E.g.   Wojewoda Mazowiecki (Mazoviecki Voivode) or  Wojewoda Zachodniopomorski  (Zachodniopomorski Voivode), depending or where you live. 

 You can check  here which Voivodeship you live in.

A. DANE OSOBOWE CUDZOZIEMCA / PERSONAL DATA OF THE FOREIGNER / DONNÉES À CARACTER PERSONNEL DE L’ÉTRANGER / ЛИЧНЫЕ ДАННЫЕ ИНОСТРАНЦА

The following section should be filled out with your personal data if you are an applicant.

But if you are submitting the application on behalf of a minor, enter this minor`s personal data. 

1. Nazwisko / Surname / Nom / Фамилия:

Enter your current name, exactly the same as in your passport. 

2. Nazwisko (nazwiska) poprzednie / Previously used surname (surnames) / Nom (noms) précédent(s) / Предыдущая фамилия (фамилии):

If you have never used any other surname than the current one, enter a  line  ( -----).

If you have used a different surname for any reasons in the past, enter the previous surname. This applies also   if you only used a different surname  temporarily (eg. if it was your  surname during your marriage but you returned to your family name after divorce).

3. Nazwisko rodowe / Family name / Nom de famille / Родовая фамилия:

Enter your family name, i.e. the surname which is received in your family at birth. 

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4. Imię (imiona) / Name (names) / Prénom (prénoms) / Имя (имена):

Enter all of your names, exactly as written in the passport. 

5. Imię (imiona) poprzednie / Previously used name (names) / Prénom (prénoms) précédent(s) / Предыдущее имя (имена):

Enter your previous name, if you have ever used a different name than you have now.

6. Imię ojca / Father’s name / Prénom du père / Имя отца:

Enter your father`s name exactly as written in your passport or any other official document (e.g. birth certificate).  

7. Imię matki / Mother’s name / Prénom de la mère / Имя матери:

Enter your mother`s name exactly as written in your passport or any other official document (e.g. birth certificate). 

8. Nazwisko rodowe matki / Mother’s maiden name / Nom de jeune fille de la mėre / Девичья фамилия матери:

Enter your mother`s maiden surname, i.e. the surname  received by your mother  at birth. 

9. Data urodzenia / Date of birth / Date de naissance / Дата рождения: | 10. Płeć / Sex / Sexe / Пол:

Enter your birth date, exactly as written in your passport. 

Enter: 
K  for woman, 
M for man. 

11. Miejsce urodzenia / Place of birth / Lieu de naissance / Место рождения:

Enter a place of you birth (city, town, village), exactly as written in your passport. 

12. Państwo urodzenia / Country of birth / Pays de naissance / Страна рождения:

Enter a name of the country you were born in. 

13. Narodowość / Nationality / Nationalité d’origin / Национальность:

Enter your nationality, e.g.  rosyjska ( =Russian), nigeryjska (=Nigerian).

14. Obywatelstwo / Citizenship / Citoyenneté / Гражданство:

Enter your citizenship, e.g.  rosyjskie (=Russian), nigeryjskie (=Nigerian).

15. Stan cywilny / Marital status / État civil / Семейное положение:

Enter your current marital status.

If you are a woman:

  • Panna ( =a single woman) - if you were never married
  • Mężatka (= a married woman)  - if you are married
  • Rozwiedziona (= a divorced woman) – if you were married and got divorced
  • Wdowa (= a widow) – if your husband died.

If you are a man: 

  • Kawaler (=a single man)  – if you were never married 
  • Żonaty (= a married man)  - if you are married
  • Rozwiedziony (= a divorced man)  - if you were married and got divorced
  • Wdowiec (= a widower) - if your wife died. 
16. Wykształcenie / Education / Education / Образование:

Enter your level of education. 

  • podstawowe – if you have graduated from the primary school
  • średnie – if you graduated from the secondary school/ high school 
  • wyższe – if you grauated from the university 
  • brak – if you have not graduated from the primary school.
17. Zawód wykonywany / Practised profession / Profession exercée / Выполняемая профессия:

Enter a position you currently work in, preferably exactly as stipulated in your work contract, e.g. shop assistant, manager. 

If you are currently not employed enter:  nie dotyczy (=not applicable).
If you attend school enter: uczeń (=pupil)
If you are studying enter: student.

18. Rysopis/Description/Signalement/Словесный портрет:
Wzrost / Height / Taille / Рост:

Enter your height in centimeters. 

Kolor oczu / Colour of eyes / Couleur des yeux / Цвет глаз:

Enter your eyes colour,  e.g. brązowe (=brown), niebieskie  (= blue), zielone (= green), szare (=grey).

Znaki szczególne / Special marks / Marques personelles / Особые приметы:

Enter any special marks that you have on your body, e.g. tatuaż (= a tattoo), blizna (=a scar). 

If you have no special marks on your body, enter:  nie dotyczy (= not applicable).

19. Numer PESEL (jeżeli został nadany) / PESEL number (if applicable) / Numéro PESEL (si attribué) / Номер PESEL (если таковой имеется):

PESEL is a 11-digits identification number which you may obtain once you register your  place of residence with the local authorities (zameldowanie) for over  3 months. 
Learn how to obtain a PESEL number here.
Note: you are not obliged to have a PESEL number. If you don`t have one enter: nie dotyczy (= not applicable).

20. Numer telefonu / Telephone number / Numéro de téléphone / Номер телефона:

Enter your current telephone number. This will facilitate communication between you and the Migration Office.

B. DOKUMENT PODRÓŻY CUDZOZIEMCA / TRAVEL DOCUMENT OF THE FOREIGNER / DOCUMENT DE VOYAGE DE L'ÉTRANGER / ПРОЕЗДНОЙ ДОКУМЕНТ ИНОСТРАНЦА find out more →

Enter below information on your current valid passport. 

Seria/Series/Série/Серия: | Numer/Number/Numéro/Номер:

Enter series and number of your current valid passport. You will find this information on a first page of your document. 

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Data wydania / Date of issue / Date de délivrance / Дата выдачи: | Data upływu ważności / Expiry date / Date de validité / Дата истечения срока действия:

Enter date of issue and date of expiry of your passport. You will find this information on a first page of your document. 

Organ wydający / Issuing authority / Autorité de délivrance / Выдан органом:

Enter a name of the country  and a name or number of the authority which issued your passport. You will find this information on a first page of your document. 

Liczba innych osób wpisanych do dokumentu podróży / Number of other persons entered in the travel document / Nombre d’autres personnes inscrites dans le document de voyage / Количество других лиц, вписанных в проездной документ:

If you have other members of your family included in your passport, enter the number of persons here. If you have no other persons included in your passport enter : 0. 

C. MIEJSCE POBYTU CUDZOZIEMCA / PLACE OF RESIDENCE OF THE FOREIGNER / LIEU DE SÉJOUR DE L'ÉTRANGER / МЕСТО ПРЕБЫВАНИЯ ИНОСТРАНЦА find out more →

In the following section you will be asked to enter details of your address in Poland. It is important that you  actually live at the address, you will be receiving numeorus letters from the Migration Office to this address. If you fail to pick it up in time, the correspondence will be considered effectively delivered to you. 

This may in consequence impact your appeal period in case of a negative decision.

1. Województwo/Voivodship/Voïvodie/ Воеводство:

If you are not sure which voivodeship you live in, check out  this map of Polish voivodeships. 

Note: the voivodeship of your residence needs to be in line with the voivode to whom you address this application. E.g. if you live in Masovian Voivodeship, you should submit your application to the Masovian Voivode (=Wojewoda Mazowiecki).

2. Powiat/District/District/Повет:

If you do not know which poviat you live in, a list of all Polish poviats may be helpful. 

3. Gmina/Municipality/Commune/Гмина:

If you do not know which municipality you live in you may find a list of all Polish municipalities helpful. 

4. Miejscowość/City/Localité/Населенный пункт:

Enter a name of a city you currently live in. 

5. Ulica/Street/Rue/Улица:

Enter a name of a street you  currently live on. 

6. Numer domu / House number / Numéro du bâtiment / Номер дома: | 7. Numer mieszkania / Apartment number / Numéro d’appartement / Номер квартиры:

Enter a number of a building you live in. 

Enter a number of your appartment/flat. 

Note: if you live in a house and have no appartment number, enter: nie dotyczy ( =not applicable) or draw a line (---).

8. Kod pocztowy / Postal code / Code postal / Почтовый индекс:

If you are not sure what your postal code is, check it out here. You will need to know your street name and number. 

9. Tytuł prawny do zajmowania przez wnioskodawcę lokalu mieszkalnego / Legal title to the apartment occupied by the applicant / Titre légal ŕ l'appartement occupé par le demandeur / Юридическое право заявителя на пребывание в жилищном помещении

If you have your own appartment or a house enter: własność (= ownership, property) 
If you are renting an appartment or a house i.e. you pay rent, enter: umowa najmu (=rent).

If you are living in an appartment or a house for free, enter: użyczenie (=lending). Note: the Migration Office will not accept such a contract unless the appartment or a house is lent to you by a close member of your family: a parent, grandparent,  sibling, child or a spouse. 

D. INFORMACJE DODATKOWE / ADDITIONAL INFORMATION / INFORMATIONS COMPLÉMENTAIRES / ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ
I. Pobyt cudzoziemca na terytorium Rzeczypospolitej Polskiej / Foreigner’s stay on the territory of the Republic of Poland / Séjour de l'étranger sur le territoire de la République de Pologne / Пребывание иностранца на территории Республики Польша:
a) poprzednie pobyty na terytorium Rzeczypospolitej Polskiej / previous stays on the territory of the Republic of Poland / séjours précédents sur le territoire de la République de Pologne / предыдущие пребывания на территории Республики Польша:

List all the documents  which have been your basis of legal stay in Poland for the last 5 years. Remember to  add their validity periods.

E.g.:

20.01.2019 - 20.08.2019 – visa
1.09.2019 – 1.09.2020 – temporary residence permit
1.09.2020 – obecnie ( =now)  – temporary residence permit

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b) aktualny pobyt na terytorium Rzeczypospolitej Polskiej / current stay on the territory of the Republic of Poland / séjour actuel sur le territoire de la République de Pologne / пребывание в настоящее время на территории Республики Польша:
1. Czy przebywa Pan (Pani) na terytorium Rzeczypospolitej Polskiej? / Are you staying in the territory of the Republic of Poland? / Êtes-vous sur le territoire de la République de Pologne? / Пребывает ли Господин (Госпожа) на территории Республики Польша?

Tick TAK(=YES) if you are currently staying on the territory of Poland. Tick  NIE (=NO) if you are currently staying outside of Poland. 

Note: if you are staying outside of Poland on the day of submitting an application, the application will be left unrecognized.

2. Proszę podać datę ostatniego wjazdu Pana (Pani) na terytorium Rzeczypospolitej Polskiej / What is the date of your last entry into the territory of the Republic of Poland? / Indiquez la date de la dernière entrée sur le territoire de la République de Pologne? / Прошу обозначить дату последнего въезда Господина (Госпожи) на территорию Республики Польша

Enter a date on which you last entered the Polish territory. 

3. W jakim celu? / What is the purpose of your stay? / Dans quel but? / С какой целью?

Enter a purpose for which  your current visa or permit was issued, e.g. work/ studies/stay with family/ visa-free movement.  

4. Na jakiej podstawie? / What are the grounds of your stay? / Sur quelle base? / На каком основании?

Tick one of the boxes depending on which document you hold currently. 

2) □ wizy/visa /visa/визы

Tick this box only if you are curently staying in Poland on the basis of a visa. 

Typ wizy / Type of visa / Type de visa / Тип визы:

Enter "C" or "D" depending on what type of visa you have. 

Seria / Series / Série / Серия: Numer / Number /Numéro / Номер:

Enter a series and nubmer of your visa. You will find this information on your document. 

Data wydania / Date of issue / Date de délivrance / Дата выдачи: | Data upływu ważności / Expiry date/ Date de validité / Дата истечения срока действия:

Enter date of issue and expiry of your visa.  You will find this information on your document. 

Okres pobytu / Period of stay / Période de séjour / Период пребывания

Enter a period of stay allowed by your visa.  You will find this information on your document.

Organ wydający / Issuing authority / Autorité de délivrance / Выдана органом:

Enter a city which an authority issuing your visa is based in.   You will find this information in your document. 

7) □ dokumentu uprawniającego do wjazdu i pobytu wydanego przez inne państwo obszaru Schengen / document entitling to entry and stay issued by other Schengen Member State / le document authorisant 1'entrée ou le séjour délivré par un État membre de l'espace Schengen / документа, разрешающего въезд и пребывание, выданного другим государством шенгенской зоны

Tick this box and answer the following questions only if you are currently staying in Poland on the basis of  a residence permit issued by a Schengen country other than Poland. 

Decyzja wydana przez / The decision issued by / La décision délivrée par / Решение выдано:

Enter which authority in another Schengen country  issued a decision granting you residence permit.  

Data wydania / Date of issue / Date de délivrance / Дата выдачи:

Enter a date your decision was issued. 

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Seria/Series/Série/ Серия: | Numer/Number/Numéro/Номер:

Enter series and number of a residence card issued by another Schengen country.  You will find this information in your document. 

Data wydania / Date of issue / Date de délivrance / Дата выдачи: | Data upływu ważności / Expiry date / Date de validité / Дата истечения срока действия:

Enter date of issue and expiry of your residence card issued by another Schengen country.   

Organ wydający / Issuing authority / Autorité de délivrance / Выдан органом:

Enter a city which an authority issuing your residence card  is based in.   You will find this information in your document. 

II. Podróże cudzoziemca i pobyty zagraniczne poza terytorium Rzeczypospolitej Polskiej w okresie ostatnich 5 lat (państwo, okres pobytu) / Foreigner’s travels and stays outside the territory of the Republic of Poland in the last 5 years (country, period of stay) / Voyages à l’étranger et séjours à l’extérieur du territoire de la République de Pologne au cours des 5 dernières années (pays, période de séjour) / Зарубежные поездки иностранца и пребывание вне территории Республики Польша в течение последних 5 лет (государство, период пребывания):

List (preferably in chronological order) all your stays outside of Poland for the last 5 years. Include visits in your country of origin.  

Eg.:
Ukraina: lipiec-sierpień 2019 (= Ukraine: July-August 2019) 
Meksyk: grudzień 2020 ( = Mexico: December 2020)
Ukraina: grudzień 2020 - styczeń 2021 ( =Ukraine: December 2020- January 2021) 

III. Pobyt na terytorium innych państw członkowskich Unii Europejskiej na podstawie dokumentu pobytowego z adnotacją „Niebieska Karta UE” wydanego przez inne niż Polska państwo członkowskie Unii Europejskiej oraz przerwy w tym pobycie (państwo, okres pobytu, seria, nr i okres ważności dokumentu pobytowego z adnotacją „Niebieska Karta UE”, państwo, które wydało ten dokument, oraz okresy przerw w pobycie na terytorium Unii Europejskiej) / Stay on the territory of other European Union Member States based on a residence document with an annotation the “EU Blue Card”, issued by the European Union Member State other than Poland, and intervals in the stay (country, period of stay, series, number and validity period of the residence document with an annotation the “EU Blue Card”, the country of the document’s issuance and the intervals in stay on the territory of the European Union) / Le séjour sur le territoire des autres États membres de l’Union européenne sur la base d’un permis de séjour mention „carte bleue européenne” délivré par un autre État membre de l’Union européenne que la Pologne et les interruptions du séjour (pays, période de séjour, numéro de série et période de validité du permis de séjour mention „carte bleue européenne”, l’État qui a délivré le document et les périodes d’interruption du séjour sur le territoire de l’Union européenne) / Пребывание на территории других государств-членов Европейского Союза на основании документа пребывания с аннотацией "Голубая Карта ЕС", выданного не Польшей, а другим государством-членом Европейского Союза, а также перерывы этого пребывания (государство, период пребывания, серия, номер и период действия документа пребывания с аннотацией "Голубая Карта ЕС", государство, которое выдало этот документ, а также периоды перерывов пребывания на территории Европейского Союза):

This question concerns you only if you have been issued an  EU Blue Card permit in any other EU country. If you have never obtained an EU Blue Card permit outside of Poland, enter: nie dotyczy (= not applicable) and move to section IV.

If you have  an EU Blue Card permit issued  outside of Poland enter  more information about the residence permit itself: 

  • name of the country which issued your EU Blue Card
  • date of issue and expiry of your EU Blue Card
  • series and number of your EU Blue Card 
  • whether you have left European Union during the period of validity of your card, and if so, enter  exact dates of your stays outside of EU.
IV. Zezwolenie na pobyt rezydenta długoterminowego Unii Europejskiej udzielone w innym państwie członkowskim Unii Europejskiej (kraj, data udzielenia, organ udzielający) / The residence permit for the long-term resident of the European Union granted in another European Union member state (country, issue date, issuing authority) / Le permis de séjour de résident de longue durée de l`Union européenne accordé dans un autre pays membre de l'Union européenne (pays, data de délivrance, autorité) / Разрешение на проживание долгосрочного резидента Европейского Союза, предоставленное другим государством-членом Европейского Союза (страна, дата предоставления, предоставляющий орган):

This question concerns you only if you have been issued a long-term EU resident permit in any other EU country. If you have never obtained a long-term EU resident permit outside of Poland, enter: nie dotyczy (= not applicable) and move to section V.

If you have  a long-term EU resident permit issued  outside of Poland enter  more information about the residence permit itself: 

  • name of the country which issued your  long-term EU resident permit
  • date of issue and expiry of your long-term EU resident permit
  • series and number of your long-term EU resident permit
V. Źródło dochodu wystarczającego do pokrycia kosztów utrzymania wnioskodawcy i członków rodziny pozostających na jego utrzymaniu oraz wysokość dochodu w ciągu ostatnich 3 lat, a w przypadku cudzoziemca posiadającego zezwolenie na pobyt czasowy w celu wykonywania pracy w zawodzie wymagającym wysokich kwalifikacji, o którym mowa w art. 212 ust. 1 pkt 1 ustawy z dnia 12 grudnia 2013 r. o cudzoziemcach, w ciągu ostatnich 2 lat / Source of income sufficient to cover maintenance costs of the applicant and the family financially dependent on the applicant and the amount of income within the last 3 years, and in the case of a foreigner having a residence permit for a fixed period for the purposes of highly qualified employment referred to in Article 212(1) point 1 of the Act of 12 December 2013 on foreigners, within the last 2 years / Source de revenu suffisant à supporter les coûts de la vie du demandeur et charges d'entretient de la famille entretenue par le demandeur et le montant du revenu au cours des 3 dernières années et, dans le cas d’un étranger titulaire d’un permis de séjour temporaire pour exercer un métier qui exige des compétences de haut niveau, visé à l’art. 212 paragraphe 1 point 1 de la Loi du 12 décembre 2013 sur les étrangers, au cours des 2 dernières années / Источник дохода, достаточного для покрытия расходов на содержание заявителя и членов семьи, которые находятся на его содержании, а также размер доходов в течение последних 3 лет, в случае иностранца, имеющего разрешение на временное пребывание для выполнения профессиональных работ, требующих высоких квалификаций, которые упомянуты в статье 212 параграф 1 п. 1 Закона от 12 декабря 2013 г. об иностранцах, в течение последних 2 лет:

List (preferably in chronological order) sources of your income as well as sources of income of your family members whom you support financially   for the last 3 years, e.g.:
1.01.2017-31.12.2017 – remuneration under the contract of employment  (enter a name of your employer)
1.02.2018-25.06.2018 – remuneration of my spouse  (name and surnme) under the contract of employment  (enter a name of your spouse`s employer)
10.06.2018 – 10.12.2018 – remuneration under a task-specific contract  (enter a name of a person who commissioned the work)

Note: If you are currently staying in Poland on the basis of a Blue Card you only have to go 2 years back in listing your sources of income. 

Learn more here about financial means you should have to be eligible for a long-term EU resident permit. 

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Liczba osób obecnie pozostających na utrzymaniu / Number of persons currently financially dependent on the applicant / Nombre de personnes actuellement à charge / Количество лиц, которые на данный момент находятся на содержании:

Enter a number of persons who are currently financially dependent on you. I.e. that they do not have their own income to support themselves or their income is not sufficient to cover their spending and you support them financially (most often persons dependent on you are your spouse or minor children who live with you and do not have sufficient income on their own). 

VI. Członkowie rodziny cudzoziemca obecnie pozostający na jego utrzymaniu, zamieszkujący na terytorium Rzeczypospolitej Polskiej / Currently dependent family members of a foreigner living on the territory of the Republic of Poland / Les membres de la famille d’un étranger qui sont actuellement à sa charge, résidant sur le territoire de la République de Pologne / Члены семьи иностранца, проживающего на территории Республики Польша, которые на данный момент находятся на его содержании:

You are required to list your family members but only the ones  who are 1) curently living  in Poland and 2) are supported by you financially.  Do not enter family members who have teir own income and are able to support themselves. 

How to fill in a table
  • Imię i nazwisko / Name and surname / Nom et prénom / Имя и фамилия
  • Płeć/Sex/Sexe/Пол - Enter K for woman, M for man
  • Data urodzenia / Date of birth / Date de naissance / Дата рождения
  • Stopień pokrewieństwa / Degree of kin / Degré de parenté / Степень родства - E.g. matka (mother), ojciec (father), córka (daughter), syn (son), mąż (husband), żona (wife), brat (brother), siostra (sister).
  • Obywatelstwo/ Citizenship/ Nationalité/ Гражданство
  • Miejsce zamieszkania / Place of residence / Domicile / Место жительства - Enter current place of residence of your family member in Poland.
VII. Posiadane ubezpieczenie zdrowotne / Health insurance coverage / Coverture assurée par l'assurance médicale / Наличие медицинской страховки:

Enter what type of health insurance you have, e.g. ZUS, private insurance policy etc. 
Learn more here about required health insurance.  

VIII. Czy jest Pan (Pani) zatrzymany(-na), umieszczony(-na) w strzeżonym ośrodku lub w areszcie dla cudzoziemców lub czy został wobec Pana (Pani) zastosowany środek zapobiegawczy w postaci zakazu opuszczania kraju lub odbywa Pan (Pani) karę pozbawienia wolności lub zastosowano wobec Pana (Pani) tymczasowe aresztowanie? / Have you been held in custody, placed in a guarded centre or detention facility for foreigners, or has a preventive measure been applied against you in the form of prohibition to leave the country, or have you been deprived of liberty or temporarily detained? / Êtes-vous détenu(e), placé(e) dans un centre surveillé ou dans un centre de détention pour étrangers, a-t-on appliqué contre vous une mesure préventive sous la forme d’une interdiction de quitter le pays, purgez-vous une peine privative de liberté ou étiez-vous placé(e) en détention provisoire? / Задержан(а) ли Господин (Госпожа), находится ли в охраняемом пункте или под арестом для иностранцев, была ли по отношению к Господину (Госпоже) применена мера пресечения в виде запрета выезда из страны или отбывает ли Господин (Госпожа) наказание в виде лишения свободы, а также применено ли по отношению к Господину (Госпоже) временное задержание?

Enter TAK (=YES) if: 

  • you are placed in a detention center  or are in any other way  deprived of your liberty by the Police or the Border Guard; 
  • you received a written decision of a prosecutor or a court order  banning you from leaving Poland  (a ban on leaving a country is usually closely connected to a criminal procedure if  you are a suspect);  
  • are imprisoned  (you were sentenced by a criminal court);
  • you are under arrest  (arrest usually happens if you are a suspect in a criminal investigation).

Enter  NIE (=NO)  if none of the above is applicable to your situation. 

IX. Czy był(a) Pan (Pani) karany(-na) sądownie na terytorium Rzeczypospolitej Polskiej? / Have you been sentenced by the courts in the territory of the Republic of Poland? / Avez-vous été condamné(e) par un tribunal sur le territoire de la République de Pologne? / Был(а) ли Господин (Госпожа) наказан(а) в судебном порядке на территории Республики Польша?

Tick  TAK (=YES) if you have been sentenced by the Polish court.  If so, give more details about your sentence:  1) year the crime was committed 2) details of the sentence ( imprisonment, fine, probation etc.) 3) whether the sentence was served/ a fine paid. 

Note: in most cases you are fully aware of the judgement of the Polish court, as you are an active participant of the proceedings. However in some cases you might not be fully aware that you have been sentenced: this might happen if the court did not know your current address. If you have some doubts whether you have been sentenced or not, consult a lawyer.  

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X. Czy toczy się przeciwko Panu (Pani) postępowanie karne lub postępowanie w sprawach o wykroczenia na terytorium Rzeczypospolitej Polskiej? / Are any penal proceedings or minor offence proceedings under way against you in the territory of the Republic of Poland? / Actuellement, faites-vous l’objet d’une procedure judiciaire ou d’une procédure pour un délit, sur le territoire de la République de Pologne? / Продолжаются ли против Господина (Госпожи) уголовные действия или действия в отношении нарушений на территории Республики Польша?

Tick TAK (=YES) if there is currently a criminal or petty crime (contravention) proceeding pending in the case of an act that you committed. This could be a small offence, like driving without a valid driving licence, or a major crime like robbery or organized crime. If you know of such a proceeding give more details of the crime or contravention below. 
Note: you might  learn of the investigation if you are questioned by the Police or a prosecutor and charged with  committing a criminal act. 

E. WZÓR PODPISU SIGNATURE SPECIMEN / MODÈLE DE LA SIGNATURE / ОБРАЗЕЦ ПОДПИСИ

Put your usual signature in the center of frame (signature should not cross the frame lines).

If you are submitting this application on behalf of a minor, leave the frame empty.

Data i podpis cudzoziemca (imię i nazwisko) / Date and signature of the foreigner (name and surname) / Date et signature de l’étranger (prénom et nom) / Дата и подпись иностранца (имя и фамилия)

Enter a date: a day of dispatch or submitting of your application. 

Our tip for applicants who submit hand-written applications: you need to submit 2  copies of the application, but both need to be signed  separately. Make a xerocopy of your application before you sign it and save time.

Your signature needs to consist of a name and a surname and be easy to read.  

(podpis) – imię i nazwisko / (signature) – name and surname / (signature) – prénom et nom / (подпись) – имя и фамилия

Your signature needs to consist of a name and a surname and be easy to read.  


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F. UZASADNIENIE WNIOSKU / JUSTIFICATION OF THE APPLICATION / JUSTIFICATION DE LA DEMANDE / ОБОСНОВАНИЕ ЗАЯВКИ find out more →

Compose a few sentences justifying your application for a longterm EU resident permit  e.g.:
Przebywam w Polsce nieprzerwanie od 5 lat (= I have been continously living in Poland for the last 5 years).
Pracuję tu i płacę tu podatki od 3 lat. (=I have worked and paid my taxes in Poland for the last 3 years) 
Posiadam urzędowe poświadczenie znajomości języka polskiego. (= I have an official language certificate confrming my Polish language skills) 
Załączone przeze mnie dokumenty potwierdzają, że spełniam warunki przyznania mi zezwolenia na pobyt rezydenta długoterminowego UE. ( =Herewith attached documents confirm that I fullfill all reguirements necessary to obtain a long-term EU resident permit )

Data i podpis cudzoziemca (imię i nazwisko) / Date and signature of the foreigner (name and surname) / Date et signature de l’étranger (prénom et nom) / Дата и подпись иностранца (имя и фамилия)

Your signature needs to consist of a name and a surname and be easy to read.  

Załączniki do wniosku / Annexes to the application / Annexes à la demande / Приложения к заявке: (załącza wnioskodawca) / (attached by the applicant) / (à joindre par le demandeur) / (добавляет заявитель) find out more →

List all your attachments here. 

Keep in mind that you may submit copies of the documents (attachments) as long as you show the originals to the office clerk while you submit your application or at a leter time during your procedure.  Do not worry if you have not  collected all of the required attachments by the time your time to submit the application comes. You may submit the outstanding documents later.
Check here for a list of required attachments.

1. Uzasadnienie/Justification/Justification/Обоснование 2. Oświadczenie/Statement/Déclaration/Заявлениe

Justification and your statement are included in your application form, you do not need to attach them as long as you submit 2 copies of your application. 

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G. OŚWIADCZENIE/STATEMENT/DECLARATION/ЗАЯВЛЕНИE find out more →

Read the above statement very carefully. It stipulates that if you knowingly wrote  false information in the application or concealed true information you might be criminally liable in line with the Polish Criminal Code.  You might also have problems obtaining a residence permit.  

Data i podpis (imię i nazwisko) cudzoziemca / Date and signature (name and surname) of the foreigner / Date et signature (prénom et nom) de l’étranger / Дата и подпись (имя и фамилия) иностранца:

Your signature needs to consist of a name and a surname and be easy to read.  If you are submitting an application on behalf of a minor  you also need to sign here. 

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POUCZENIE/INSTRUCTION/INSTRUCTION/ИНСТРУКЦИЯ
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ADNOTACJE URZĘDOWE / OFFICIAL NOTES / ANNOTATIONS DE L’OFFICE / СЛУЖЕБНЫЕ АННОТАЦИИ

Leave all the below sections  empty, these are to be filled in by the Migration Office.

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