1034
| ID | 1034 |
|---|
| Data | 2012-10-19 |
|---|
| Symbol | 2012/10/19/1034 |
|---|
| Instytucja | Zakład Ubezpieczeń Społecznych |
|---|
| Nazwa | Zaświadczenie o ubezpieczeniu - Umowa między Rzecząpospolitą Polską a Kanadą - PL-CAN01 |
|---|
| Czy Aktualny | 1 |
|---|
Ustawy (1)
| URI://Dziennik_Ustaw/2009/133/1097/3/2 | Art. 3 ust. 2 Porozumienia Administracyjnego z 2 kwietnia 2008 r. w sprawie stosowania Umowy o zabezpieczeniu społecznym między Rzecząpospolitą Polską a Kanadą (Dz. U. z 2009 r. Nr 133, poz. 1097) |
|---|
Pliki
Styl
<?xml version="1.0" encoding="UTF-8"?><xsl:stylesheet xmlns:xsl="http://www.w3.org/1999/XSL/Transform" version="1.0" xmlns:wnio="http://crd.gov.pl/wzor/2012/10/19/1034/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.w3.org/1999/XSL/Transform http://www.w3.org/2007/schema-for-xslt20.xsd">
<xsl:template match="/">
<html>
<head>
<title>
PL-CAN01 (Formularz) - Zakład Ubezpieczeń Społecznych
</title>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8"/>
</head>
<body style="text-align:center;">
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;">
<div style="border-style: solid; border-width:1px; left:0px; width:885px; height:1270px; margin-bottom:10px; margin-left:0px; margin-top:0px; text-align:left;">
<div style="width:840px; height:1212px; border-style: none; left:21px; top:14px; position:absolute;">
<div style="left:315px; top:39px; text-align:center; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">UMOWA O ZABEZPIECZENIU SPOŁECZNYM <br/>MIĘDZY RZECZĄPOSPOLITĄ POLSKĄ A KANADĄ<br/>Z DNIA 2 KWIETNIA 2008 ROKU</div>
<div style="left:294px; top:88px; text-align:center; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">SOCIAL SECURITY AGREEMENT<br/>BETWEEN THE REPUBLIC OF POLAND AND CANADA<br/>DATED THE 2nd OF APRIL 2008</div>
<div style="left:298px; top:146px; text-align:center; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">ACCORD SUR LA SECURITE SOCIALE<br/>ENTRE LA REPUBLIQUE DE POLOGNE ET LE CANADA<br/>DU 2 AVRIL 2008</div>
<div style="left:278px; top:329px; text-align:center; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">Art. 6b, 7, 9 w związku z art. 7, art. 9 Umowy<br/> Art. 4 Porozumienia Administracyjnego<br/>
<br/>Art.6b, 7, 9 with reference to art. 7, art. 9 of the Agreement<br/> Art. 4 of Administrative Memorandum of Understanding<br/>
<br/>Art. 6b, 7, 9 lu conjointement avec l’art. 7, art. 9 de l’ Accord<br/>Art. 4 de l'Arrangement Administratif</div>
<div style="left:65px; top:572px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.</div>
<div style="left:99px; top:602px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Pracownik</div>
<div style="left:98px; top:617px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Employee</div>
<div style="left:98px; top:631px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Travailleur</div>
<div style="left:315px; top:603px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Osoba pracująca na własny rachunek</div>
<div style="left:314px; top:618px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Self-employed person</div>
<div style="left:314px; top:632px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Travailleur non salarié</div>
<div style="left:277px; top:607px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:DzialalnoscNaWlasnyRachunek ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:94px; top:552px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Informacje dotyczące osoby ubezpieczonej</div>
<div style="left:95px; top:567px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Information pertaining to the insured person</div>
<div style="left:94px; top:583px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Renseignements concernant l’assuré</div>
<div style="left:737px; top:10px; width:80px; height:27px; border-style: solid; border-width: 1px; position:absolute;">
<div style="left:12px; top:6px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">PL-CAN01</div>
</div>
<div style="font-size:16px; font-weight:bold; text-align:center; left:205px; top:212px; text-align:center; font-family:arial; display:block; position:absolute; overflow:hidden;">ZAŚWIADCZENIE DOTYCZĄCE WŁAŚCIWEGO USTAWODAWSTWA<br/>CERTIFICATE PERTAINING TO PROPER JURISDICTION<br/>ATTESTATION CONCERNANT LA LEGISLATION APPLICABLE</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:51px; top:560px; width:1px; height:495px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:794px; top:595px; width:1px; height:460px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:85px; top:559px; width:1px; height:37px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:52px; top:595px; width:743px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="height:1px; left:52px; top:1054px; width:744px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:51px; top:560px; width:35px; height:1px; display:block; position:absolute"/>
<div style="left:62px; top:656px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.1 Nazwisko:</div>
<div style="left:82px; top:673px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Name</div>
<div style="left:82px; top:693px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nom</div>
<div style="left:61px; top:717px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.2 Nazwisko rodowe:</div>
<div style="left:81px; top:730px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Name at birth</div>
<div style="left:81px; top:744px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nom de naissance</div>
<div style="left:65px; top:769px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.3 Imię:</div>
<div style="left:59px; top:824px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.4 Data urodzenia:</div>
<div style="left:80px; top:840px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Date of birth</div>
<div style="left:80px; top:854px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Date de naissance</div>
<div style="left:85px; top:787px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Given name</div>
<div style="left:86px; top:804px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Prénom</div>
<div style="left:197px; top:711px; width:589px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:NazwiskoRodowe"/>
</div>
</div>
<div style="left:168px; top:769px; width:618px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:Imie"/>
</div>
</div>
<div style="left:147px; top:652px; width:639px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:Nazwisko"/>
</div>
</div>
<div style="left:315px; top:824px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.5 Obywatelstwo:</div>
<div style="left:336px; top:840px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Citizenship</div>
<div style="left:336px; top:854px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nationalité</div>
<div style="left:427px; top:810px; width:359px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:Obywatelstwo"/>
</div>
</div>
<div style="left:64px; top:896px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.6 Adres :</div>
<div style="font-size:11px; font-family:verdana; left:116px; top:889px; display:block; position:absolute; overflow:hidden;">(1)</div>
<div style="left:81px; top:911px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Address</div>
<div style="left:81px; top:927px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Adresse</div>
<div style="left:60px; top:970px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">1.7 Numer identyfikacyjny w Polsce :</div>
<div style="font-size:11px; font-family:verdana; left:252px; top:963px; display:block; position:absolute; overflow:hidden;">(2)</div>
<div style="left:77px; top:985px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Personal identification number in Poland</div>
<div style="left:77px; top:1001px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">No d’identification en Pologne</div>
<div style="left:61px; top:606px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:Pracownik ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:172px; top:810px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:DataUrodzenia !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:DataUrodzenia, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:DataUrodzenia, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:DataUrodzenia, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:136px; top:884px; width:653px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:Adres"/>
</div>
</div>
<div style="left:335px; top:961px; width:451px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczaceOsobyUbezpieczonej/wnio:NumerIdentyfikacyjnyWPolsce"/>
</div>
</div>
</div>
</div>
</div>
<hr style="visibility: hidden;"/>
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;">
<div style="border-style: solid; border-width:1px; left:0px; width:885px; height:1270px; margin-bottom:10px; margin-left:0px; margin-top:0px; text-align:left;">
<div style="left:20px; top:10px; height:1216px; border-style: none; width:805px; position:absolute;">
<div style="left:73px; top:11px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Informacje dotyczące pracodawcy</div>
<div style="left:74px; top:25px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Information pertaining to the employer</div>
<div style="left:74px; top:39px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Renseignements concernant l’ employeur</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="top:19px; left:27px; width:1px; height:337px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="width:1px; left:788px; top:54px; height:303px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:63px; top:18px; width:1px; height:37px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:28px; top:54px; height:1px; width:760px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="height:1px; left:27px; top:356px; width:762px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:27px; top:18px; width:36px; height:1px; display:block; position:absolute"/>
<div style="left:65px; top:73px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:InformacjeDotyczacePracodawcy/wnio:Pracodawca ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="width:25px; left:68px; top:484px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:ZatrudnionaPrzezWymienionegoPracodawce ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:43px; top:31px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">2.</div>
<div style="left:39px; top:133px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">2.1 Nazwa lub rodzaj działalności:</div>
<div style="left:60px; top:147px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Name or nature of business</div>
<div style="left:61px; top:164px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nom ou nature de l’activité</div>
<div style="left:103px; top:65px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Pracodawca</div>
<div style="left:102px; top:98px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Employeur</div>
<div style="left:102px; top:81px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Employer</div>
<div style="left:264px; top:81px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Work performed as self-employed</div>
<div style="left:264px; top:98px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Activité non salariée</div>
<div style="left:227px; top:73px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:InformacjeDotyczacePracodawcy/wnio:DzialalnoscNaWlasnyRachunek ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:265px; top:65px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Działalność na własny rachunek</div>
<div style="left:39px; top:188px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">2.2 Adres :</div>
<div style="left:60px; top:202px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Address</div>
<div style="left:61px; top:219px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Adresse</div>
<div style="left:35px; top:268px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">2.3 Numer identyfikacyjny w Polsce :</div>
<div style="left:56px; top:282px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Business identification number in Poland</div>
<div style="left:57px; top:299px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">No d’identification en Pologne</div>
<div style="left:292px; top:258px; width:485px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczacePracodawcy/wnio:NumerIdentyfikacyjnyWPolsce"/>
</div>
</div>
<div style="font-size:11px; font-family:verdana; left:229px; top:267px; display:block; position:absolute; overflow:hidden;">(3)</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="width:1px; left:788px; top:479px; height:561px; display:block; position:absolute"/>
<div style="left:40px; top:453px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.</div>
<div style="left:42px; top:492px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.1</div>
<div style="left:105px; top:484px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">jest zatrudniona przez wymienionego pracodawcę od</div>
<div style="left:105px; top:500px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">has been employed by the said employer from</div>
<div style="left:105px; top:515px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">est employé par l’employeur mentionné ci-dessus depuis le</div>
<div style="left:70px; top:433px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Wyżej wymieniona osoba ubezpieczona</div>
<div style="left:72px; top:449px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">The above-mentioned insured person</div>
<div style="left:72px; top:464px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">L’assuré désigné ci-dessus</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:25px; top:440px; width:1px; height:600px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="width:1px; height:38px; left:60px; top:441px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:26px; top:478px; width:763px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:26px; top:1039px; width:763px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="width:35px; height:1px; left:26px; top:440px; display:block; position:absolute"/>
<div style="width:25px; left:68px; top:547px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DzialalnoscNaWlasnyRachunek ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:42px; top:555px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.2</div>
<div style="left:105px; top:547px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">prowadzi działalność na własny rachunek od</div>
<div style="left:105px; top:563px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">has been self-employed from</div>
<div style="left:105px; top:578px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">exerce une activité non salariée depuis le</div>
<div style="width:25px; left:68px; top:621px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:ZostalaOddelegowana ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:42px; top:629px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.3</div>
<div style="left:105px; top:621px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">została oddelegowana od</div>
<div style="left:608px; top:611px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">do</div>
<div style="left:608px; top:623px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">to</div>
<div style="left:608px; top:637px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">au</div>
<div style="left:105px; top:637px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">was seconded from</div>
<div style="left:105px; top:652px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">a été détaché du </div>
<div style="width:25px; left:70px; top:684px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:ProwadziDzialalnoscWPolsceKanadzie ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:44px; top:692px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.4</div>
<div style="left:107px; top:684px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">prowadzi działalność na terytorium Polski i Kanady od</div>
<div style="left:610px; top:685px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">do</div>
<div style="left:612px; top:699px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">to</div>
<div style="left:610px; top:711px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">au</div>
<div style="left:107px; top:700px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">pursues activities on the territory of Poland and Canada from</div>
<div style="left:107px; top:715px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">exerce une activité non salariée sur le territoire de la Pologne et du Canada du</div>
<div style="width:25px; left:71px; top:744px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:PrzenosiDzialalnosc ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:45px; top:752px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.5</div>
<div style="left:108px; top:744px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">przenosi czasowo działalność od<br/>do firmy wymienionej poniżej: </div>
<div style="left:108px; top:772px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">temporarily transfers activity from<br/>to the firm mentioned below </div>
<div style="left:108px; top:799px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">transfère temporairement son activité du <br/>à l’entreprise mentionnée ci-dessous </div>
<div style="left:45px; top:845px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.6</div>
<div style="left:71px; top:839px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nazwa przedsiębiorstwa, na rzecz którego osoba ubezpieczona będzie wykonywała pracę w Kanadzie</div>
<div style="left:71px; top:855px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Name of the company on behalf of which insured person will be working in Canada</div>
<div style="left:71px; top:870px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Nom de l’entreprise au profit de laquelle l’assuré exercera le travail au Canada</div>
<div style="left:45px; top:928px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3.7</div>
<div style="left:397px; top:1178px; width:26px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">2</div>
<div style="left:71px; top:925px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Adres w Kanadzie:</div>
<div style="left:71px; top:941px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Address in Canada</div>
<div style="left:71px; top:956px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Adresse au Canada</div>
<div style="left:612px; top:746px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">do</div>
<div style="left:612px; top:770px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">to</div>
<div style="left:613px; top:797px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">au</div>
<div style="left:93px; top:183px; font-size:11px; font-family:verdana; display:block; position:absolute; overflow:hidden;">(1)</div>
<div type="textarea" style="height:51px; left:63px; top:981px; width:709px; font-size:14.1px; display:block; border-style: solid; border-width: 1px; border-color:#000000; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:AdresWKanadzie"/>
</div>
</div>
<div style="left:65px; top:890px; width:707px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:NazwaPrzedsiebiorstwa"/>
</div>
</div>
<div style="left:232px; top:119px; width:548px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczacePracodawcy/wnio:NazwaRodzajDzialalnosci"/>
</div>
</div>
<div style="left:115px; top:178px; width:665px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InformacjeDotyczacePracodawcy/wnio:Adres"/>
</div>
</div>
<div style="left:454px; top:485px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaZatrudnienia !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaZatrudnienia, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaZatrudnienia, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaZatrudnienia, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:454px; top:547px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaDzialalnosci !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaDzialalnosci, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaDzialalnosci, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:DataRozpoczeciaDzialalnosci, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:454px; top:610px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Od !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Od, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Od, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Od, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:644px; top:610px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Do !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Do, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Do, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresOddelegowania/wnio:Do, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:454px; top:666px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Od !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Od, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Od, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Od, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:640px; top:667px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Do !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Do, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Do, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresProwadzeniaDzialalnosci/wnio:Do, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:461px; top:733px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Od !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Od, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Od, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Od, 1, 4)"/>
</xsl:if>
</div>
</div>
<div style="left:638px; top:733px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:if test="//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Do !=''">
<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Do, 9, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Do, 6, 2)"/>/<xsl:value-of select="substring(//wnio:TrescDokumentu/wnio:OsobaUbezpieczona/wnio:OkresPrzeniesieniaDzialalnosci/wnio:Do, 1, 4)"/>
</xsl:if>
</div>
</div>
</div>
</div>
</div>
<hr style="visibility: hidden;"/>
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;">
<div style="border-style: solid; border-width:1px; left:0px; width:885px; height:1270px; margin-bottom:10px; margin-left:0px; margin-top:0px; text-align:left;">
<div style="left:13px; top:11px; width:848px; height:1215px; border-style: none; position:absolute;">
<div style="left:74px; top:37px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">L’assuré reste soumis à la législation polonaise</div>
<div style="left:40px; top:64px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">4.1 na mocy artykułu:</div>
<div style="left:63px; top:80px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">on the strength of article:</div>
<div style="left:63px; top:97px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">conformément aux dispositions de l’article:</div>
<div style="left:40px; top:32px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">4.</div>
<div style="left:73px; top:11px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Osoba ubezpieczona podlega ustawodawstwu polskiemu</div>
<div style="left:74px; top:25px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">The insured person is subject to the jurisdiction of Poland</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:28px; top:19px; width:1px; height:356px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:746px; top:54px; width:1px; height:321px; display:block; position:absolute"/>
<div style="left:72px; top:431px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Institution compétente dont la législation est applicable</div>
<div style="left:36px; top:477px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.1 Nazwa:</div>
<div style="left:59px; top:493px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Name</div>
<div style="left:59px; top:510px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Dénomination</div>
<div style="left:38px; top:426px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.</div>
<div style="left:71px; top:405px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Instytucja właściwa, której ustawodawstwu osoba ubezpieczona podlega</div>
<div style="left:72px; top:419px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Competent institution to which jurisdiction the insured person is subject</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:26px; top:413px; width:1px; height:450px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="top:449px; left:743px; width:1px; height:414px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:61px; top:413px; width:1px; height:37px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:27px; top:449px; width:717px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="width:717px; height:1px; left:27px; top:862px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:26px; top:412px; width:36px; height:1px; display:block; position:absolute"/>
<div style="left:36px; top:598px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.2. Adres:</div>
<div style="left:59px; top:614px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Address</div>
<div style="left:59px; top:631px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Adresse</div>
<div style="left:36px; top:733px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.3 Pieczęć</div>
<div style="left:416px; top:1179px; width:23px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">3</div>
<div style="left:59px; top:749px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Stamp</div>
<div style="left:59px; top:766px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Cachet</div>
<div style="left:375px; top:733px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.4 Data</div>
<div style="left:398px; top:749px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Date</div>
<div style="left:398px; top:766px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Date</div>
<div style="left:375px; top:809px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5.5 Podpis</div>
<div style="left:398px; top:825px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Signature</div>
<div style="left:398px; top:842px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Signature</div>
<div style="width:236px; left:467px; top:790px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
</div>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:63px; top:19px; width:1px; height:35px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:29px; top:54px; width:718px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:29px; top:374px; width:718px; height:1px; display:block; position:absolute"/>
<img src="data:image/gif;base64, R0lGODdhAQABAOcdAAAAAAEBAQICAgMDAwQEBAUFBQYGBgcHBwgICAkJCQoKCgsLCwwMDA0NDQ4O Dg8PDxAQEBERERISEhMTExQUFBUVFRYWFhcXFxgYGBkZGRoaGhsbGxwcHB0dHR4eHh8fHyAgICEh ISIiIiMjIyQkJCUlJSYmJicnJygoKCkpKSoqKisrKywsLC0tLS4uLi8vLzAwMDExMTIyMjMzMzQ0 NDU1NTY2Njc3Nzg4ODk5OTo6Ojs7Ozw8PD09PT4+Pj8/P0BAQEFBQUJCQkNDQ0REREVFRUZGRkdH R0hISElJSUpKSktLS0xMTE1NTU5OTk9PT1BQUFFRUVJSUlNTU1RUVFVVVVZWVldXV1hYWFlZWVpa WltbW1xcXF1dXV5eXl9fX2BgYGFhYWJiYmNjY2RkZGVlZWZmZmdnZ2hoaGlpaWpqamtra2xsbG1t bW5ubm9vb3BwcHFxcXJycnNzc3R0dHV1dXZ2dnd3d3h4eHl5eXp6ent7e3x8fH19fX5+fn9/f4CA gIGBgYKCgoODg4SEhIWFhYaGhoeHh4iIiImJiYqKiouLi4yMjI2NjY6Ojo+Pj5CQkJGRkZKSkpOT k5SUlJWVlZaWlpeXl5iYmJmZmZqampubm5ycnJ2dnZ6enp+fn6CgoKGhoaKioqOjo6SkpKWlpaam pqenp6ioqKmpqaqqqqurq6ysrK2tra6urq+vr7CwsLGxsbKysrOzs7S0tLW1tba2tre3t7i4uLm5 ubq6uru7u7y8vL29vb6+vr+/v8DAwMHBwcLCwsPDw8TExMXFxcbGxsfHx8jIyMnJycrKysvLy8zM zM3Nzc7Ozs/Pz9DQ0NHR0dLS0tPT09TU1NXV1dbW1tfX19jY2NnZ2dra2tvb29zc3N3d3d7e3t/f 3+Dg4OHh4eLi4uPj4+Tk5OXl5ebm5ufn5+jo6Onp6erq6uvr6+zs7O3t7e7u7u/v7/Dw8PHx8fLy 8vPz8/T09PX19fb29vf39/j4+Pn5+fr6+vv7+/z8/P39/f7+/v///ywAAAAAAQABAAAIBAABBAQA Ozs=" alt="img" style="left:28px; top:18px; width:36px; height:1px; display:block; position:absolute"/>
<div style="left:39px; top:208px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">4.2 od</div>
<div style="left:370px; top:65px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">6(b)</div>
<div style="left:370px; top:97px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">7</div>
<div style="left:370px; top:170px; width:31px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">9</div>
<div style="left:370px; top:118px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">9 w związku z art. 7</div>
<div style="left:370px; top:130px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">9 with reference to art 7</div>
<div style="left:370px; top:143px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">9 lu conjointement avec l’ art. 7</div>
<div style="left:82px; top:222px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">from</div>
<div style="left:83px; top:239px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">du</div>
<div style="left:95px; top:265px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">na podstawie zgody z dnia</div>
<div style="left:96px; top:280px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">on the grounds of consent dated</div>
<div style="left:96px; top:296px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">au vertu de l’accord du</div>
<div style="left:95px; top:323px; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">(w przypadku art. 9 w związku z art. 7, art. 9 Umowy)</div>
<div style="left:96px; top:338px; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">(in the case of art. 9 with reference to art. 7, art. 9 of Agreement )</div>
<div style="left:96px; top:354px; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">(au cas de l’art. 9 lu conjointement avec l’art. 7, l’art. 9 de l’Accord)</div>
<div style="left:37px; top:264px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">4.3.</div>
<div style="left:462px; top:265px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">znak</div>
<div style="left:463px; top:280px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">ref No</div>
<div style="left:463px; top:296px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">réf. No</div>
<div style="left:515px; top:255px; width:220px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Znak"/>
</div>
</div>
<div style="left:331px; top:60px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Artykul/wnio:Art6b ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:331px; top:89px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Artykul/wnio:Art7 ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:331px; top:118px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Artykul/wnio:Art9WZwiazkuZArt7 ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:331px; top:162px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Artykul/wnio:Art9 ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:66px; top:264px; width:25px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<xsl:if test="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:NaPodstawieZgodyZDnia ='true'">
<div style="padding-left: 6px; padding-top: 2px;">X</div>
</xsl:if>
</div>
<div style="left:370px; top:215px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">do</div>
<div style="left:370px; top:227px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">to</div>
<div style="left:370px; top:241px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">au</div>
<div style="left:120px; top:203px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:OkresPodlegania/wnio:Od"/>
</div>
</div>
<div style="left:416px; top:203px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:OkresPodlegania/wnio:Do"/>
</div>
</div>
<div style="left:282px; top:254px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:PodleganiePrzepisomPrawaWPolsce/wnio:Data"/>
</div>
</div>
<div style="left:147px; top:462px; width:555px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InstytucjaWlasciwaWPolsce/wnio:Nazwa"/>
</div>
</div>
<div style="left:147px; top:589px; width:555px; height:25px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InstytucjaWlasciwaWPolsce/wnio:Adres"/>
</div>
</div>
<div style="left:467px; top:718px; height:25px; width:140px; display:block; border-style: solid; border-width: 1px; position:absolute; overflow:hidden; background-color:#ffffff;">
<div style="padding-left:5px; padding-top:3px;">
<xsl:value-of select="//wnio:TrescDokumentu/wnio:InstytucjaWlasciwaWPolsce/wnio:Data"/>
</div>
</div>
</div>
</div>
</div>
<hr style="visibility: hidden;"/>
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;">
<div style="border-style: solid; border-width:1px; left:0px; width:885px; height:1270px; margin-bottom:10px; margin-left:0px; margin-top:0px; text-align:left;">
<div style="left:13px; top:11px; width:848px; border-style: none; height:1215px; position:absolute;">
<div style="left:400px; top:10px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">POUCZENIE</div>
<div style="left:407px; top:582px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">UWAGI</div>
<div style="left:393px; top:602px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">COMMENTS</div>
<div style="left:407px; top:622px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">NOTES</div>
<div style="left:42px; top:651px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">(1)</div>
<div style="left:76px; top:651px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Ulica, numer domu, numer mieszkania, kod pocztowy, miejscowość, gmina/powiat/województwo</div>
<div style="left:76px; top:671px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Street name and number, apartment number, postal code, town/village, commune, district, province.<br/>Rue, numéro, numéro du logement, code postal, localité, commune/ district/ voïvodie</div>
<div style="left:42px; top:712px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">(2)</div>
<div style="left:76px; top:712px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">PESEL i NIP, a w razie gdy ubezpieczonemu nie nadano tych numerów lub jednego z nich – seria i numer dowodu osobistego <br/>lub paszportu.</div>
<div style="left:76px; top:742px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">PESEL and NIP, and in cases the insured has not been assigned one or both of these numbers – series and number of the Country ID or Passport<br/>PESEL et NIP, à défaut de ces deux numéros ou de l’un de ces numéros – la série et le numéro de la carte d’identité ou du passeport.</div>
<div style="left:41px; top:794px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">(3)</div>
<div style="left:75px; top:794px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">NIP i REGON pracodawcy lub firmy prowadzonej przez osobę pracującą na własny rachunek.</div>
<div style="left:77px; top:809px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">NIP and REGON of the employer or the firm run by the self-employed person<br/>NIP et REGON d’employeur ou d’entreprise dirigée par le travailleur non salarié.</div>
<div style="left:425px; top:1187px; width:24px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">4</div>
<div style="left:396px; top:30px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">INSTRUCTION</div>
<div style="left:392px; top:50px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">INSTRUCTIONS</div>
<div style="left:69px; top:79px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Formularz należy wypełnić drukowanymi literami wpisując tekst wyłącznie w zaznaczonych kropkami miejscach.</div>
<div style="left:70px; top:132px; width:779px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Właściwa terenowa jednostka Zakładu Ubezpieczeń Społecznych wystawia formularz na wniosek pracodawcy lub osoby pracującej na własny rachunek. Formularz potwierdza okres, w którym pracownik lub osoba pracująca na własny rachunek w dalszym ciągu podlega polskim przepisom prawnym. Kopię tego formularza wysyła się do właściwej instytucji kanadyjskiej, a drugą kopię pozostawia się zainteresowanemu jako dowód, że w stosunku do niego nie są stosowane kanadyjskie przepisy prawne o obowiązkowym ubezpieczeniu.</div>
<div style="left:70px; top:324px; width:779px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">W przypadkach, o których mowa w art. 9 w związku z art. 7 oraz art. 9 Umowy właściwa terenowa jednostka Zakładu Ubezpieczeń Społecznych wystawia formularz, po uzyskaniu pisemnej zgody otrzymanej od instytucji kanadyjskiej.</div>
<div style="left:70px; top:433px; width:779px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Artykuł 9 w związku z art. 7 Umowy dotyczy sytuacji udzielenia zgody na przedłużenie okresu delegowania dla pracownika.</div>
<div style="left:70px; top:508px; width:779px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Artykuł 9 Umowy dotyczy przypadków wyjątkowych innych niż wyżej wymieniony.</div>
<div style="left:69px; top:99px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">This form is to be filled in with printed characters exclusively in spaces provided on dotted lines.<br/>Le formulaire doit être rempli en caractères d’imprimerie en utilisant uniquement les lignes pointillées.</div>
<div style="left:70px; top:205px; width:779px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">The competent local branch of Social Insurance Institution issues this form on request of the employer or self-employed person. This form confirms the period over which an employee or a self-employed person has been now subject to jurisdiction of Poland. A copy of this form is to be sent to the proper Canadian institution and a second copy is to be kept by the applicant as a proof that the legal regulations applicable to mandatory insurance in Canada are not applied in relation to him/her.<br/>L’unité locale compétente de l’Institution des Assurances Sociales délivre un formulaire à la demande du travailleur ou travailleur non salarié. Le formulaire atteste la période dans laquelle le travailleur ou le travailleur non salarié pourra continuer à être soumis à la législation polonaise. Une copie de ce formulaire est adressée à l’institution canadienne, l‘intéressé obtient une deuxième copie en tant que la preuve qu’il n’est pas soumis à la législation canadienne obligatoire de sécurité sociale.</div>
<div style="left:70px; top:356px; width:779px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">In cases mentioned in art.9 of the Agreement, with reference to art. 7, art. 9 of Agreement the competent local branch of Social Insurance Institution issues this form after having obtained written consent from competent authorities or an institution of the other Country appointed by them.<br/>Au cas de l’article 9 lu conjointement avec l’article 7 et l’article 9 de l’Accord, l’ unité locale compétente de l’Institution des Assurances Sociales délivre le formulaire après l’obtention de l’accord reçu par écrit de la part de l’institution canadienne.</div>
<div style="left:70px; top:453px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Article 9 with reference to art. 7 of Agreement concerns situation where approval for extension of posting was granted to an employee<br/>L’article 9 lu conjointement avec l’article 7 de l’Accord concerne la situation où la prolongation de la période du détachement est accordée.</div>
<div style="left:70px; top:523px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Article 9 of Agreement concerns other exceptional situations than one mentioned above<br/>L’article 9 de la Convention concerne les cas exceptionnels, autres que celui désigné ci-dessus .</div>
</div>
</div>
</div>
<hr style="visibility: hidden;"/>
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;">
<div style="border-style: solid; border-width:1px; left:0px; width:885px; height:1270px; margin-bottom:10px; margin-left:0px; margin-top:0px; text-align:left;">
<div style="left:13px; top:11px; width:848px; border-style: none; height:1215px; position:absolute;">
<div style="left:316px; top:11px; font-size:12px; font-weight:bold; text-align:center; font-family:arial; display:block; position:absolute; overflow:hidden;">DODATKOWE INFORMACJE<br/>ADDITIONAL INFORMATION<br/>RENSEIGNEMENTS COMPLEMENTAIRES</div>
<div style="left:354px; top:379px; font-size:12px; font-weight:bold; text-align:center; font-family:arial; display:block; position:absolute; overflow:hidden;">INSTYTUCJE WŁAŚCIWE<br/>COMPETENT INSTITUTIONS<br/>INSTITUTIONS COMPETENTES</div>
<div style="left:69px; top:79px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Pracodawca oddelegowanego pracownika lub osoba pracująca na własny rachunek ma obowiązek poinformować polską instytucję:</div>
<div style="left:63px; top:444px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">• dla celów realizacji Umowy:</div>
<div style="left:186px; top:444px; font-size:12px; font-style:italic; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">art.6(b), 7</div>
<div style="left:63px; top:502px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Terenowe jednostki Zakładu Ubezpieczeń Społecznych właściwe dla siedziby pracodawcy lub firmy prowadzonej przez osobę pracującą <br/>na własny rachunek.</div>
<div style="left:69px; top:103px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">•o tym, że delegowanie lub przeniesienie działalności nie doszło do skutku,<br/>•o wcześniejszym powrocie przed upływem okresu oddelegowania/ przeniesienia działalności,<br/>•o zaprzestaniu prowadzenia działalności w przypadku równoczesnego wykonywania działalności na terenie Polski i Kanady.<br/>Instytucja polska powiadamia o tym instytucję kanadyjską.</div>
<div style="left:69px; top:171px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Employer of the seconded employee or self-employed person is obliged to inform Polish institution about:<br/>•the fact, that posting or transfer of his/her activity didn’t take place<br/>•earlier return to country before the end of posting period/transferring activity<br/>•about casing self-employed activity in the case of simultaneous activities on the territory of Poland and Canada<br/>Polish institution informs about this fact Canadian institution.<br/>
<br/>L’employeur du travailleur détaché ou le travailleur non salarié est obligé d ‘informer l’institution polonaise du fait que:<br/>•le détachement ou le transfert de l’activité n‘a pas eu lieu,<br/>•son retour/transfert de son activité a eu lieu avant la fin de la période prévue de détachement,<br/>•l’activité a été interrompue au cas d’exercice de l’activité en même temps sur le territoire de la Pologne et du Canada.<br/>L’institution polonaise informe de ce fait l’institution canadienne.</div>
<div style="left:63px; top:464px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">for the purpose of implementation of of the Agreement<br/>pour la réalisation de l’art. 6(b), 7 de l’Accord</div>
<div style="left:268px; top:463px; width:73px; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">art. 6(b), 7</div>
<div style="left:63px; top:608px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">• dla celów realizacji Umowy:</div>
<div style="left:191px; top:608px; font-size:12px; font-style:italic; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">art. 9 w związku z art. 7, art. 9</div>
<div style="left:63px; top:670px; font-size:12px; font-weight:bold; font-family:arial; display:block; position:absolute; overflow:hidden;">Centrala Zakładu Ubezpieczeń Społecznych</div>
<div style="left:63px; top:690px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Headquarters of Social Insurance Institution<br/>Centrale de l’Institution des Assurances Sociales</div>
<div style="left:418px; top:1187px; width:26px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">5</div>
<div style="left:63px; top:628px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">for the purpose of implementation of of the Agreement<br/>pour la réalisation de l’ art. 9 lu conjointement avec l’art. 7, art. 9 de l’Accord</div>
<div style="left:267px; top:628px; width:200px; font-size:12px; font-style:italic; font-family:arial; display:block; position:absolute; overflow:hidden;">art. 9 with reference to art. 7, art. 9</div>
<div style="left:63px; top:536px; width:753px; font-family:arial; font-size:12px; display:block; position:absolute; overflow:hidden;">Local branches of Social Insurance Institution with competence over the area where the headquarters of the employer or the firm run by the self-employed person.<br/>Les unités locales de l’Institution des Assurances Sociales compétentes par rapport au siège de l’employeur ou d’entreprise dirigée par le travailleur non salarié.</div>
</div>
</div>
</div>
<hr style="visibility: hidden;"/>
<div style="width:885px; margin-left:auto; margin-right:auto; position:relative; text-align:left; page-break-after:always;"/>
</body>
</html>
</xsl:template>
<xsl:template name="spacja">
<xsl:param name="tekst"/>
<xsl:choose>
<xsl:when test="contains($tekst,' ')">
<xsl:call-template name="tabulacja">
<xsl:with-param name="tekst">
<xsl:value-of select="substring-before($tekst,' ')"/>
</xsl:with-param>
</xsl:call-template> <xsl:call-template name="spacja">
<xsl:with-param name="tekst">
<xsl:value-of select="substring-after($tekst,' ')"/>
</xsl:with-param>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:call-template name="tabulacja">
<xsl:with-param name="tekst">
<xsl:value-of select="$tekst"/>
</xsl:with-param>
</xsl:call-template>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="tabulacja">
<xsl:param name="tekst"/>
<xsl:choose>
<xsl:when test="contains($tekst,'	')">
<xsl:value-of select="substring-before($tekst,'	')"/> <xsl:call-template name="tabulacja">
<xsl:with-param name="tekst">
<xsl:value-of select="substring-after($tekst,'	')"/>
</xsl:with-param>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:value-of select="$tekst"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="formatowanie">
<xsl:param name="tekst"/>
<xsl:choose>
<xsl:when test="contains($tekst,' ')">
<xsl:call-template name="spacja">
<xsl:with-param name="tekst">
<xsl:value-of select="substring-before($tekst,' ')"/>
</xsl:with-param>
</xsl:call-template>
<br/>
<xsl:call-template name="formatowanie">
<xsl:with-param name="tekst">
<xsl:value-of select="substring-after($tekst,' ')"/>
</xsl:with-param>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:call-template name="spacja">
<xsl:with-param name="tekst">
<xsl:value-of select="$tekst"/>
</xsl:with-param>
</xsl:call-template>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
</xsl:stylesheet>