12833
| ID | 12833 |
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| Data | 2023-08-28 |
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| Symbol | 2023/08/28/12833 |
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| Instytucja | Urząd Gminy Izabelin |
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| Nazwa | Wniosek o przyznanie szkolnego stypendium socjalnego/zasiłku szkolnego |
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| Czy Aktualny | 1 |
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Ustawy (1)
| URI://Dziennik_Ustaw/2023/57/16b/1 | Ustawa z dnia 17 lutego 2005 r. o informatyzacji działalności podmiotów realizujących zadania publiczne (t.j. Dz. U. z 2023 r. poz. 57). |
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Pliki
Styl
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<title>Dokument elektroniczny</title>
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<body><style type="text/css" media="all">pre {font-family: inherit;}</style><table style="width: 100%;" border="0" cellpadding="5"><tbody><tr><td style="text-align: right;"><span style="font-family: verdana, geneva; font-size: small;">Miejscowość <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:MiejscowoscDokumentu"/></span></xsl:if></span> , data <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/meta:Data/meta:Czas"/></span></xsl:if></span></span></td>
</tr><tr><td style="text-align: right;"><span style="font-family: verdana, geneva; font-size: small;"> </span></td>
</tr><tr><td style="background-color: #4e41bd; text-align: center;"><span style="color: #ffffff; font-size: medium; font-family: verdana, geneva;"><strong>Wniosek <br/>o przyznanie <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:WniosekWybor"/></span></xsl:if></span></strong></span></td>
</tr><tr><td style="text-align: left;"><span style="font-family: verdana, geneva; font-size: small;"> </span></td>
</tr></tbody></table><table style="width: 100%;" border="0" cellpadding="5"><tbody><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong><strong>ADRESAT</strong></strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong><br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/inst:NazwaInstytucji"/></span></xsl:if></span><br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:Ulica/@rodzajUlicy"/></span></xsl:if></span> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:Ulica"/></span></xsl:if></span> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:Budynek"/></span></xsl:if></span><br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:KodPocztowy"/></span></xsl:if></span> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:Miejscowosc"/></span></xsl:if></span><br/><br/></strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<table style="width: 100%;" border="0"><tbody><tr><td colspan="2">
<p>Na podstawie <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:Art1"/></span></xsl:if></span> składam wniosek o przyznanie na rok szkolny <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:RokSzkolny"/></span></xsl:if></span><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:CoWniosku"/></span></xsl:if></span></p>
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</tr></tbody></table></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong>1. Wnioskodawca</strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:DaneDokumentu/meta:Tworcy/meta:Tworca/meta:Podmiot/oso:Osoba"><xsl:if test="true()">
<table style="width: 100%;" border="1" cellpadding="5"><tbody><tr><td style="width: 20%; background-color: #d9d9d9;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong>DANE OSOBY</strong></span></td>
</tr><tr><td style="width: 20%;"><span style="font-size: small; font-family: verdana, geneva;">Imię<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="oso:Imie"/></span></xsl:if></span><br/></span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Nazwisko<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="oso:Nazwisko"/></span></xsl:if></span><br/></span></td>
</tr><tr><td style="width: 20%;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;">PESEL<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="oso:IdOsoby/oso:PESEL"/></span></xsl:if></span></span></td>
</tr><tr><td colspan="2">
<xsl:for-each select="adr:Adres"><xsl:if test="true()">
<table style="width: 100%;" border="1" cellpadding="5"><tbody><tr><td style="background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong>ADRES ZAMIESZKANIA</strong></span></td>
</tr><tr><td style="width: 19%;"><span style="font-size: small; font-family: verdana, geneva;">Miejscowość<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Miejscowosc"/></span></xsl:if></span><br/></span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Ulica/@rodzajUlicy"/></span></xsl:if></span><br/><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Ulica"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 19%;"><span style="font-size: small; font-family: verdana, geneva;">Numer budynku <br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Budynek"/></span></xsl:if></span><br/></span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Numer lokalu<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Lokal"/></span></xsl:if></span><br/></span></td>
</tr><tr><td style="width: 19%;"><span style="font-family: verdana, geneva; font-size: small;">Kod pocztowy<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:KodPocztowy"/></span></xsl:if></span><br/></span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Poczta<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Poczta"/></span></xsl:if></span><br/></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong>DANE KONTAKTOWE</strong></span></td>
</tr><tr><td style="width: 19%;"><span style="font-size: small; font-family: verdana, geneva;">Numer telefonu<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Kontakt/adr:Telefon"/></span></xsl:if></span><br/></span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Adres email<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Kontakt/adr:Email"/></span></xsl:if></span><br/></span></td>
</tr><tr><td style="width: 19%; background-color: #d9d9d9;" colspan="2"><strong><span style="font-family: verdana, geneva; font-size: small;">ADRES DO KORESPONDENCJI</span></strong></td>
</tr><tr><td style="width: 19%;" colspan="2"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Adres/adr:Uwagi"/></span></xsl:if></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:DaneUcznia"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td><span style="font-family: verdana, geneva; font-size: small;"><strong>2. Dane ucznia/wychowanka ubiegającego się o <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Tytul"/></span></xsl:if></span></strong></span></td>
</tr><tr><td>
<xsl:for-each select="wnio:Dane"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Imię</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Imie"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Nazwisko</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Nazwisko"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Data urodzenia</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Data"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Miejsce urodzenia</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:MiejsceUrodzenia"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">PESEL</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Pesel"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Imię ojca</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:ImOjca"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Imię matki</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:ImMatki"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td>
<xsl:for-each select="oso:Osoba"><xsl:if test="true()">
<xsl:for-each select="adr:Adres"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td colspan="2"><strong><span style="font-family: verdana, geneva; font-size: small;">Miejsce zamieszkania ucznia</span></strong></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Miejscowość</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Miejscowosc"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Ulica/@rodzajUlicy"/></span></xsl:if></span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Ulica/@rodzajUlicy"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Nr domu</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Budynek"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Nr mieszkania</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Lokal"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Kod pocztowy</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:KodPocztowy"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Poczta</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Poczta"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each><xsl:for-each select="adr:Kontakt"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Telefon kontaktowy</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="adr:Telefon"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></xsl:if></xsl:for-each></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:DaneSzkoly"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong>3. Informacja o szkole, do której uczęszcza uczeń w roku szkolnym <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Tytul"/></span></xsl:if></span></strong></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Nazwa szkoły</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:NazwaSzkoly"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Klasa</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Klasa"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Rok nauki</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Rok"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:DaneUzasadniajace"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong>4. Dane uzasadnienia przyznania świadczenia pomocy materialnej</strong></span></td>
</tr><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong><span>a) Oświadczam, że moja rodzina składa się z niżej wymienionych osób, które pozostają we wspólnym gospodarstwie domowym:</span></strong></span></td>
</tr><tr><td colspan="2">
<xsl:for-each select="wnio:Tabela"><xsl:if test="true()">
<table style="width: 100%;" border="1"><tbody><tr><td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;">Lp.</span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;">Imię i </span><br/><span style="font-family: verdana, geneva; font-size: small;">nazwisko</span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;">Data </span><br/><span style="font-family: verdana, geneva; font-size: small;">urodzenia</span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;">Miejsce</span><br/><span style="font-family: verdana, geneva; font-size: small;"> pracy/nauki</span></td>
<td style="width: 12%;">
<p><span style="font-family: verdana, geneva; font-size: small;">Stopień</span><br/><span style="font-family: verdana, geneva; font-size: small;">pokrewieństwa</span></p>
</td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;">Źródło </span><br/><span style="font-family: verdana, geneva; font-size: small;">dochodu</span></td>
<td style="width: 12%;">
<p><span style="font-family: verdana, geneva; font-size: small;">Wysokość</span><br/><span style="font-family: verdana, geneva; font-size: small;">dochodu </span><br/><span style="font-family: verdana, geneva; font-size: small;">netto w zł</span></p>
</td>
</tr></tbody></table><xsl:for-each select="wnio:Tabelka"><xsl:if test="true()">
<table style="width: 100%;" border="1"><tbody><tr><td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Lp"/></span></xsl:if></span></span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:ImNazw"/></span></xsl:if></span></span></td>
<td style="width: 12%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Data"/></span></xsl:if></span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Miejsce"/></span></xsl:if></span></span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Stopien"/></span></xsl:if></span></span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Zrodlo"/></span></xsl:if></span></span></td>
<td style="width: 12%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Wysokosc"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></xsl:if></xsl:for-each></td>
</tr><tr><td><span style="font-family: verdana, geneva; font-size: small;">Łączny dochód netto na całe gospodarstw:</span></td>
<td><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Laczny"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Średni miesięczny dochód netto na jednego członka gospodarstwa domowego wynosi:</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:SredniNaMieszkanca"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;" colspan="2"> </td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">b) Uczeń ubiegający się o stypendium szkolne <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:OtrzymujeWybor"/></span></xsl:if></span> inne stypendium o charakterze socjalnym przyznane przez</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:PrzezKogoPrzyznane"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">w wysokości </span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Wysokosc"/></span></xsl:if></span></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">na okres</span></td>
<td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Okres"/></span></xsl:if></span></span></td>
</tr><tr><td colspan="2"> </td>
</tr><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;">c) Uzasadnienie przyznania pomocy</span></td>
</tr><tr><td colspan="2"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Uzasadnienie"/></span></xsl:if></span></td>
</tr><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;">Proszę o przekazanie środków pieniężnych przyznanych w ramach szkolnego stypendium/zasiłku przelewem na poniższy numer konta bankowego:</span></td>
</tr><tr><td colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Bank"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong>POUCZENIE</strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc"><xsl:if test="true()"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:POUCZENIE"/></span></xsl:if></span></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><strong>KLAUZULA INFORMACYJNA</strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc"><xsl:if test="true()"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:RODO"/></span></xsl:if></span></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong><strong>Załączone do wniosku dokumenty</strong></strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/str:Zalaczniki"><xsl:if test="true()">
<xsl:for-each select="str:Zalacznik"><xsl:if test="true()">
<table style="width: 100%;" border="0" cellpadding="5"><tbody><tr><td><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span><xsl:value-of select="str:DaneZalacznika/../@nazwaPliku"/></span></xsl:if></span></span></td>
</tr><tr><td><span style="font-family: verdana, geneva; font-size: small;">Opis załącznika: <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="str:OpisZalacznika"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px; background-color: #d9d9d9;" colspan="2"><span style="font-size: small; font-family: verdana, geneva;"><strong>PODPIS</strong></span></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:Podpis"><xsl:if test="true()">
<table style="width: 100%;" border="0" cellpadding="5"><tbody><tr><td style="width: 50%;"><span style="font-size: small; font-family: verdana, geneva;">Imię</span><br/><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Imie"/></span></xsl:if></span></span></td>
<td colspan="10"><span style="font-size: small; font-family: verdana, geneva;">Nazwisko<br/><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Nazwisko"/></span></xsl:if></span><br/></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr><tr><td style="width: 100%; border-style: solid; border-width: 1px;" colspan="2">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:Podpis"><xsl:if test="true()">
<table style="width: 100%;" border="0" cellpadding="5"><tbody><tr><td><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span><xsl:choose><xsl:when test="contains(concat(concat(' ', normalize-space(wnio:Oswiadczenie)),' '), ' 1 ' )"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[ ]</span></xsl:otherwise></xsl:choose><label><span>Oświadczam, że rezygnuję z doręczania pism za pomocą środków komunikacji elektronicznej w niniejszym postępowaniu.</span></label></span><br/></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each></td>
</tr></tbody></table><p> </p>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:Zalacznik1"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td colspan="2">
<p style="text-align: center;"><span style="font-family: verdana, geneva; font-size: small;"><strong><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Tytul"/></span></xsl:if></span></strong></span><br/><span style="font-family: verdana, geneva; font-size: small;"><strong>udokumentowanie dochodu rodziny wymagane przy składaniu wniosku</strong></span></p>
</td>
</tr><tr><td colspan="2"> </td>
</tr><tr><td colspan="2">
<table style="width: 100%;" border="1"><tbody><tr><td style="width: 50%; text-align: center;"><strong><span style="font-family: verdana, geneva; font-size: small;">Źródła dochodów</span></strong></td>
<td style="width: 50%; text-align: center;"><strong><span style="font-family: verdana, geneva; font-size: small;">Wymagane dokumenty</span></strong></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Umowa o pracę, Umowa zlecenie, Umowa o dzieło</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis1"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Działalność gospodarcza</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis2"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Emerytura lub renta</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis3"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Świadczenie rodzinne, świadczenie pomocy społecznej GOPS (zasiłek stały, zasiłek okresowy, zaliczka alimentacyjna)</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis4"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Alimenty</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis5"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Urząd Pracy</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis6"/></span></xsl:if></span></td>
</tr><tr><td style="width: 50%;"><span style="font-family: verdana, geneva; font-size: small;">Inne (stypendia, praktyki szkolne)</span></td>
<td style="width: 50%;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Opis7"/></span></xsl:if></span></td>
</tr></tbody></table></td>
</tr></tbody></table></xsl:if></xsl:for-each><xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:Zalacznik2"><xsl:if test="true()">
<table style="width: 100%;" border="0"><tbody><tr><td style="text-align: center;" colspan="2"><span style="font-family: verdana, geneva;"><strong><span style="font-size: small;">ZAŚWIADCZENIE</span></strong></span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;">Zaświadcza się,że</span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Imie"/></span></xsl:if></span><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Nazwisko"/></span></xsl:if></span> urodzony/a <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Data"/></span></xsl:if></span></span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;">PESEL <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Pesel"/></span></xsl:if></span> zamieszkały/a <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Miesjce"/></span></xsl:if></span></span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;">w roku szkolnym <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Rok"/></span></xsl:if></span> jest uczniem</span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Szkola"/></span></xsl:if></span></span></td>
</tr><tr><td style="text-align: left;" colspan="2"><span style="font-family: verdana, geneva; font-size: small;">Klasa <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:Klasa"/></span></xsl:if></span></span></td>
</tr></tbody></table></xsl:if></xsl:for-each><p><span style="font-family: verdana, geneva; font-size: small;"> </span></p><span style="display: none;"/><div style="clear: both;"/><div/><xsl:call-template name="Podpis"/></body>
</html>
</xsl:for-each>
</xsl:template>
<xsl:template name="Podpis">
<div style="float:left;text-align: right;font-size: 10px;font-family: Verdana;line-height: 20px;">
<table style="float: right;">
<tr>
<td style="width: 340px;">
<h2>Podpisy elektroniczne</h2>
<p align="center" style="text-align: center;font-size: 10px;font-family: Verdana;line-height: 20px;">
<xsl:if test="string-length(//wnio:Dokument/ds:Signature/ds:SignatureValue) > 0">
<xsl:text>Dokument został podpisany, aby go zweryfikować należy użyć oprogramowania do weryfikacji podpisu</xsl:text>
<br/>
<xsl:for-each select="//wnio:Dokument/ds:Signature/ds:Object">
<xsl:if test="descendant::*[local-name() = 'SigningTime']">
<xsl:value-of select="descendant::*[local-name() = 'SigningTime']"/>
</xsl:if>
<xsl:choose>
<xsl:when test="descendant::*[local-name() = 'PodpisZP']"> Podpis profilem zaufanym: <xsl:value-of select="descendant::*[local-name() = 'Imie']"/><xsl:text> </xsl:text><xsl:value-of select="descendant::*[local-name() = 'Nazwisko']"/><br/></xsl:when>
</xsl:choose>
</xsl:for-each>
</xsl:if>
</p>
</td>
</tr>
</table>
</div>
</xsl:template>
</xsl:stylesheet>