Application - step by step - Association for Legal Intervention

Permit for permanent residence

Click on the document below to view instructions for the questions on the permanent residence application form.

(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 STAŁY APPLICATION FOR THE PERMANENT RESIDENCE PERMIT LA DEMANDE POUR LE PERMIS DE RÉSIDENCE PERMANENTE ЗАЯВКА НА ПРЕДОСТАВЛЕНИЕ ИНОСТРАНЦУ РАЗРЕШЕНИЯ НА ПОСТОЯННОЕ ПРЕБЫВАНИЕ 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 in the past (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.

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

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

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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.

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 ИНОСТРАНЦA find out more →

Enter below information on your current valid passport.

Seria / Series/ Numer / Number /

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:

Entere 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 / Town (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.

D. INFORMACJE DODATKOWE / ADDITIONAL INFORMATION / INFORMATIONS COMPLÉMENTAIRES / ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ find out more →

You should fill out the following section D only if you are currently married.

If you are not married enter: nie dotyczy ( =not applicable).

I. Dane dotyczące małżonka / Date of the spouse / Données du conjoint / Данные, касающиеся супруга:

1. Nazwisko / Surname / Nom / Фамилия:

Enter your spouse`s surname, exactly as written in their passport.

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

Enter your spouse`s names, exactly as written in their passport.

3. Imię (imiona) poprzednie / Previous name (names) / Prénom (prénoms) précédents / Предыдущие имя ( имена):

Enter your spouse`s previous names if they have changed it.

4. Nazwisko (nazwiska) poprzednie / Previous surname (surnames) / Nom (noms) précédents / Предыдущие фамилия (фамилии)

Enter your spouse`s previous surname if they have ever used a different surname (eg. maide name of your wife).

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5. Data urodzenia / Date of birth / Date de naissance / Дата рождения

Enter your spouse`s birth date, exactly as written in their passport.

6. / Sex / Sexe / Пол:

Enter:
K - for female
M - for male.

7. Obywatelstwo/ Citizenship / Nationalité / Гражданство:

Enter yous spouse`s citizenship.

8. Miejsce zamieszkania/ Place of residence/ Domicile / Место проживания

Enter your spouse`s current place of residence, be it in Poland or abroad.

Miejscowość / City / Localité / Населенный пункт: Ulica / Street / Rue / Улица: Numer domu / House number / Numéro du bâtiment / Номер дома: Numer mieszkania / Apartment number / Numéro d’appartement / Номер квартиры: Numer mieszkania / Apartment number / Numéro d’appartement / Номер квартиры: Kod pocztowy / Postal code / Code postal / Почтовый индекс: Państwo/ Country / Pays / Страна:

Enter a city/town/village your spouse lives in.
Enter a name of a street your spouse lives on.
Enter a number of a building your spouse lives in
Enter a number of a flat/appartment your spouse lives in. If they do not have one, enter : nie dotyczy ( =not applicable).
Enter your spouse`s postal code.
Enter a name of a country your spouse lives in.

II. 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: (okresy i podstawa pobytu) / (periods and basis of stay) / (périodes et base de séjour) / (периоды и основание пребывания) find out more →

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

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: (zaznaczyć znakiem „X” odpowiednią rubrykę) / (tick the appropriate box with „X”) / (mettre un „X” dans la case adéquate) / (обозначить знаком „X” соответствующую графу)

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? (zaznaczyć znakiem „X” odpowiednią rubrykę) / (tick the appropriate box with „X”) / (mettre un „X” dans la case adéquate) / (обозначить знаком „X” соответствующую графу)

Tick one of the boxes depending on which document you hold currently. Leave all boxes unchecked if you have no right to legal stay on the territory of Poland.

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Typ wizy / Type of visa / Type de visa / тип визы:: Tick this box only if you are curently staying in Poland on the basis of a visa.
Seria / Series / Série / Серия: Numer / Number /Numéro / Номер:: Enter series and numer 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.
3)zezwolenia na pobyt czasowy/ temporary residence permit / permis de séjour temporaire / разрешения на временное пребывание 4 ) statusu uchodźcy, ochrony uzupełniającej, zgody na pobyt ze względów humanitarnych / the refugee status, the subsidiary protection, the permit for stay for humanitarian reasons / statut de réfugié, protection subsidiaire, permis de séjour pour des raisons humanitaires / статуса беженца, дополнительной защиты, согласия на пребывание по гуманитарным причинам 5) zgody na pobyt tolerowany / the permit for tolerated stay / permis de séjour toléré / согласия на толерантное пребывание 6) azylu/ asylum/ asile / убежища
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.
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.
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III. 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)

IV. 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 Pani (Pana) 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.

V. 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.

VI. 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.

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VII. Czy wywiązuje się Pan (Pani) z zobowiązań podatkowych wobec Skarbu Państwa? / Do you comply with fiscal obligations to the state treasury? / Est-ce que vous vous acquittez des obligations déclaratives et contributives fiscales envers le budget d’État? / Исполняет ли Господин (Госпожа) налоговые обязанности в отношении Государственной Казны?

Tick TAK ( =YES) if you have paid all your taxes within the statutory deadline or were not obliged to pay any taxes in Poland.

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.

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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 permanent residence permit e.g.:

Posiadam polskie korzenie i/lub Kartę Polaka i planuję osiedlić się w Polsce na stałe (=I have Polish roots and/or Pole`s Card and plan to settle down in Poland).
Przebywam w Polsce od X lat a od 3 lat jestem żoną/mężem obywatela polskiego i oboje mieszkamy w Polsce ( = I have been residing in Poland for X years and have been married to a Polish citizen for 3 years. Me and my spouse both live in Poland.)
Przebywam w Polsce nieprzerwanie od 5 lat na podstawie ochrony uzupełniającej/statusu uchodźcy ( I have have been residing continously in Poland for the last 5 years on a basisi of refugee status or subsidiary protection)

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)

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 Świadomy odpowiedzialności karnej wynikającej z art. 233 Kodeksu karnego oświadczam, że dane i informacje zawarte we wniosku są prawdziwe. Aware of criminal liability under Article 233 of the Penal Code, I declare that the data and information contained in the application are true. Conscient de la responsabilité criminelle en vertu de l'article 233 du code pénal, je déclare que les données et informations contenues dans la demande sont vraies. Осознавая уголовную ответственность, следующую из ст. 233 Уголовного кодекса заявляю, что данные и сведения содержащиеся в заявке достоверные. Jestem świadomy, że złożenie wniosku lub dołączenie dokumentów zawierających nieprawdziwe dane osobowe lub fałszywe informacje, a także zeznanie nieprawdy w postępowaniu o udzielenie zezwolenia na pobyt stały, zatajenie prawdy, podrobienie, przerobienie dokumentu w celu użycia go jako autentycznego lub używanie takiego dokumentu jako autentycznego spowoduje odmowę udzielenia zezwolenia lub jego cofnięcie. I am aware that the submission of the application or attachment of documents containing untrue personal data or false information as well as stating the untrue, concealing the truth, forging, processing document for the purpose of using as authentic one or using such a document as an authentic one in the proceedings for granting permanent residence permit shall result in the refusal or cancellation of the permit. Je déclare être conscient(e) que le dépôt d’une demande ou des documents en annexe contenant des coordonnées ou informations fausses, ainsi qu’une fausse déclaration lors de la procédure de la délivrance du permis de residence permanente, la dissimulation des faits, la falsification ou la rectification d’un document dans le but de l’utiliser comme authentique ou l’utilisation d’un tel document comme authentique causera le refus ou l’annulation de l’autorisation. Я осознаю, что составление заявки или добавление документов, которые содержат ложные личные данные или ложную информацию, а также если показания в производстве по предоставлению разрешения на постоянное пребывание содержат ложные сведения, скрывают правду, подделаны, если изменен документ с целью использования его как аутентичного или такой документ использован как аутентичный, то это повлечет отказ в предоставлении разрешения или его отклонение. Oświadczam, że znana jest mi treść art. 233 § 1 i 6 ustawy z dnia 6 czerwca 1997 r. – Kodeks karny (Dz. U. Nr 88, poz. 553, z późn. zm.)1). I hereby declare that I am familiar with the contents of Article 233 § 1 and 6 of the Act of 6 June 1997 – Penal Code (Journal of Laws No. 88, item 553, as amended)2). Je certifie que je connais le contenu de l’art. 233 § 1 et 6 de la loi du 6 juin 1997 – Code pénal (Journal officiel n°88, article 553, tel que modifié)3). Заявляю, что мне известно содержание статьи 233 § 1 и 6 закона от 6 июня 1997 г. - Уголовный кодекс (З. В. №88, поз.553. с посл. Изм.): 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.
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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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: The following sections are to be filled in by the Migration Office.

Application – step by step

Permit for permanent residence