12943
| ID | 12943 |
|---|
| Data | 2023-10-20 |
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| Symbol | 2023/10/20/12943 |
|---|
| Instytucja | Urząd Miasta i Gminy w Międzychodzie |
|---|
| Nazwa | Wniosek o udostępnianie danych w systemie eUrząd innej osobie fizycznej |
|---|
| Czy Aktualny | 1 |
|---|
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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<div class="form-name text-center">
<div class="form-sign">
WN-4
</div><div>
Wniosek o udostępnianie danych w systemie eUrząd innej osobie fizycznej
</div>
</div><div class="section">
<div class="title">
A. MIEJSCE SKŁADANIA WNIOSKU
</div><xsl:for-each select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja">
<div class="editable section-indent">
<table style="width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="text-center text-middle adresat"><div style="width:100%;">
<strong>
<br/><span>
<xsl:value-of select="inst:NazwaInstytucji"/>
</span><br/><span>
<xsl:value-of select="adr:Adres/adr:KodPocztowy"/>
</span><span> </span><span>
<xsl:value-of select="adr:Adres/adr:Miejscowosc"/>
</span>,<span> </span><span> </span><span>
<xsl:value-of select="adr:Adres/adr:Ulica"/>
</span><span> </span><span>
<xsl:value-of select="adr:Adres/adr:Budynek"/>
</span><br/><xsl:if test="string(adr:Kontakt/adr:Telefon) != ''">
Tel:<span> </span><span>
<xsl:value-of select="adr:Kontakt/adr:Telefon"/>
</span>
</xsl:if>
</strong>
</div></td>
</tr>
</table>
</div>
</xsl:for-each>
</div><div class="section">
<div class="title">
B. DANE UPOWAŻNIAJĄCEGO
</div><div class="title">
B1. DANE IDENTYFIKACYJNE
</div><div class="editable section-indent">
<xsl:variable name="lp_start_0" select="1"/>
<xsl:for-each select="wnio:DaneDokumentu/str:Nadawcy/meta:Podmiot/oso:Osoba">
<div style="border-bottom:1px solid black;">
<table class="table-with-borders" style="width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_1">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>Nazwisko</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:Nazwisko) != ''">
<span class="field-text">
<xsl:value-of select="oso:Nazwisko"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_2">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>Imie</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:Imie) != ''">
<span class="field-text">
<xsl:value-of select="oso:Imie"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_3">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>Login ePuap</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(../../../../wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Wnioskodawca/wnio:LoginEPuap) != ''">
<span class="field-text">
<xsl:value-of select="../../../../wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Wnioskodawca/wnio:LoginEPuap"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_4">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>Email</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(adr:Kontakt/adr:Email) != ''">
<span class="field-text">
<xsl:value-of select="adr:Kontakt/adr:Email"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_5">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>PESEL</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:IdOsoby/oso:PESEL) != ''">
<span class="field-text">
<xsl:value-of select="oso:IdOsoby/oso:PESEL"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_6">
<xsl:with-param name="lp_start" select="$lp_start_0"/>
</xsl:call-template>NIP</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:IdOsoby/oso:NIP) != ''">
<span class="field-text">
<xsl:value-of select="oso:IdOsoby/oso:NIP"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr>
</table>
</div>
</xsl:for-each>
</div><div class="subtitle1">
B1. ADRES ZAMIESZKANIA
</div><div class="editable section-indent">
<xsl:variable name="lp_start_7" select="4"/>
<xsl:for-each select="wnio:DaneDokumentu/str:Nadawcy/meta:Podmiot/oso:Osoba/adr:Adres">
<div class="table-with-borders">
<table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="full-width" style="width:66%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_8">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Kraj</div>
<div class="field-value">
<span class="field-text">
<xsl:choose>
<xsl:when test="adr:Kraj='PL'">POLSKA</xsl:when>
<xsl:otherwise>☐</xsl:otherwise>
</xsl:choose>
</span>
</div>
</div></td><td style="width:34%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_9">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Województwo</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Wojewodztwo) != ''">
<span class="field-text">
<xsl:value-of select="adr:Wojewodztwo"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_10">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Powiat</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Powiat) != ''">
<span class="field-text">
<xsl:value-of select="adr:Powiat"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_11">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Gmina</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Gmina) != ''">
<span class="field-text">
<xsl:value-of select="adr:Gmina"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:34%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_12">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Miejscowość</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Miejscowosc) != ''">
<span class="field-text">
<xsl:value-of select="adr:Miejscowosc"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_13">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Kod pocztowy</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:KodPocztowy) != ''">
<span class="field-text">
<xsl:value-of select="adr:KodPocztowy"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:67%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_14">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Poczta</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Poczta) != ''">
<span class="field-text">
<xsl:value-of select="adr:Poczta"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:66%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_15">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Ulica</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Ulica) != ''">
<span class="field-text">
<xsl:value-of select="adr:Ulica"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:22%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_16">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Nr domu</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Budynek) != ''">
<span class="field-text">
<xsl:value-of select="adr:Budynek"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:22%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_17">
<xsl:with-param name="lp_start" select="$lp_start_7"/>
</xsl:call-template>Nr lokalu</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Lokal) != ''">
<span class="field-text">
<xsl:value-of select="adr:Lokal"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table>
</div>
</xsl:for-each>
</div>
</div><xsl:for-each select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja">
<div class="wrap darker section" style="border:1px solid black;">
<div class="text-output">
Wnioskodawca może upoważnic inne osoby do dostepu do systemu "e-Urząd<span> </span><span class="text-output">
<xsl:value-of select="adr:Adres/adr:Miejscowosc"/>
</span>" :<span> </span><br/>
</div>W takim przypadku:<ul>
<li>
<strong>
osoba upoważniona
</strong>winna<strong>
posiadać konto na platformie ePuap, swój identyfikator (login)
</strong>oraz<strong>
profil zaufany
</strong><span> </span>
</li>
</ul>
</div>
</xsl:for-each><div class="section">
<div class="title">
C. DANE OSOBY UPOWAŻNIONEJ DO UZYSKANIA DOSTĘPU DO DANYCH PUBLIKOWANYCH W PLATFORMIE "e-Urząd<span> </span><span style="display:inline-block;">
<xsl:value-of select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja/adr:Adres/adr:Miejscowosc"/>
</span>"
</div><xsl:if test="count(wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Upowaznieni/wnio:Upowazniony) >0">
<div class="editable section-indent">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Upowaznieni/wnio:Upowazniony">
<table class="darker bolder min-height30" style="border-top:1px solid black;border-bottom:1px solid black;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="subtitle1"><div style="width:100%;">
Osoba upoważniona:
</div></td><td/>
</tr>
</table><xsl:for-each select="wnio:OsobaFizyczna">
<div class="table-with-borders">
<table class="table-with-borders" style="width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_18"/>Nazwisko</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:Nazwisko) != ''">
<span class="field-text">
<xsl:value-of select="oso:Nazwisko"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_19"/>Imię</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:Imie) != ''">
<span class="field-text">
<xsl:value-of select="oso:Imie"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_20"/>Login ePuap</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(wnio:LoginEPuap) != ''">
<span class="field-text">
<xsl:value-of select="wnio:LoginEPuap"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_21"/>Email</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(../adr:Kontakt/adr:Email) != ''">
<span class="field-text">
<xsl:value-of select="../adr:Kontakt/adr:Email"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_22"/>PESEL</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:IdOsoby/oso:PESEL) != ''">
<span class="field-text">
<xsl:value-of select="oso:IdOsoby/oso:PESEL"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr><tr style="vertical-align: top;">
<td class="text-middle input-medium text-center"><div class="field" style="width:100%;">
<div class="text-left field-label"><span class="text-left"><xsl:call-template name="lp_tamplate_23"/>NIP</span></div>
<div class="field-value">
<xsl:choose>
<xsl:when test="string(oso:IdOsoby/oso:NIP) != ''">
<span class="field-text">
<xsl:value-of select="oso:IdOsoby/oso:NIP"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div></td>
</tr>
</table>
</div>
</xsl:for-each><xsl:variable name="lp_start_24" select="7"/>
<table class="darker min-height30" style="border-top:1px solid black;border-bottom:1px solid black;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td><div style="width:100%;">
Adres osoby upoważnionej:
</div></td>
</tr>
</table><xsl:for-each select="adr:Adres">
<div class="table-with-borders" style="border-top:1px solid black;">
<table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td class="full-width" style="width:66%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_25">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Kraj</div>
<div class="field-value">
<span class="field-text">
<xsl:choose>
<xsl:when test="adr:Kraj='PL'">POLSKA</xsl:when>
<xsl:otherwise>☐</xsl:otherwise>
</xsl:choose>
</span>
</div>
</div></td><td style="width:34%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_26">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Województwo</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Wojewodztwo) != ''">
<span class="field-text">
<xsl:value-of select="adr:Wojewodztwo"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_27">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Powiat</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Powiat) != ''">
<span class="field-text">
<xsl:value-of select="adr:Powiat"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_28">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Gmina</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Gmina) != ''">
<span class="field-text">
<xsl:value-of select="adr:Gmina"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:34%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_29">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Miejscowość</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Miejscowosc) != ''">
<span class="field-text">
<xsl:value-of select="adr:Miejscowosc"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_30">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Kod pocztowy</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:KodPocztowy) != ''">
<span class="field-text">
<xsl:value-of select="adr:KodPocztowy"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:67%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_31">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Poczta</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Poczta) != ''">
<span class="field-text">
<xsl:value-of select="adr:Poczta"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:66%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_32">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Ulica</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Ulica) != ''">
<span class="field-text">
<xsl:value-of select="adr:Ulica"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:22%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_33">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Nr domu</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Budynek) != ''">
<span class="field-text">
<xsl:value-of select="adr:Budynek"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:22%;"><div class="field" style="width:100%;">
<div class="field-label"><xsl:call-template name="lp_tamplate_34">
<xsl:with-param name="lp_start" select="$lp_start_24"/>
</xsl:call-template>Nr lokalu</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Lokal) != ''">
<span class="field-text">
<xsl:value-of select="adr:Lokal"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table>
</div>
</xsl:for-each>
</xsl:for-each>
</div>
</xsl:if>
</div><div class="section">
<div class="title">
Oświadczenie
</div><div class="editable section-indent">
<div class="wrap field">
<div class="field-value">
<span class="field-items">
<span>
<span class="radioChecker">
<xsl:choose>
<xsl:when test="wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Oswiadczenie='T'">☒</xsl:when>
<xsl:otherwise>☐</xsl:otherwise>
</xsl:choose>
</span>
Oświadczam, iż rezygnuję z doręczania pism za pomocą środków komunikacji elektronicznej zgodnie z art. 39¹ k.p.a. §1d Kodeksu postępowania administracyjnego (Dz. U. 2017 poz. 1257).
</span>
</span>
</div>
</div>
</div>
</div><div class="section">
<div class="title" style="border-bottom:none;">
Informacja
</div>
</div><xsl:for-each select="wnio:DaneDokumentu/str:Adresaci/meta:Podmiot/inst:Instytucja">
<div class="wrap section" style="border-top:none;">
Zgodnie z art. 13 oraz 14 ogólnego rozporządzenia o ochronie danych osobowych z dnia 27 kwietnia 2016 r. – RODO (Dz.U.UE. z 2016 r., L 119, poz. 1), Burmistrz Międzychodu informuje, iż:<ul>
<li>
Administratorem Pani/Pana danych osobowych przetwarzanych w Urzędzie Miasta i Gminy w Międzychodzie przy ulicy Marszałka Piłsudskiego 2 jest Gmina Międzychód, reprezentowana przez Burmistrza Międzychodu.
</li><br/><li>
Kontakt, w zakresie czynności przetwarzania danych osobowych: Inspektor Ochrony Danych Osobowych – inspektor@miedzychod.pl.
</li><br/><li>
Pani/Pana dane osobowe będą przetwarzane na podstawie Art. 6 ust. 1 lit. c RODO
</li><br/><li>
Odbiorcą Pani/Pana danych osobowych będą przeszkoleni i upoważnieni pracownicy do przetwarzania tych danych w zakresie wynikającym z zakresu obowiązków, podmioty uprawnione do uzyskania danych osobowych na podstawie przepisów prawa lub na podstawie umowy.
</li><br/><li>
Pani/Pana dane osobowe nie będą przekazywane do państwa trzeciego/organizacji międzynarodowej.
</li><br/><li>
Pani/Pana dane osobowe będą przechowywane zgodnie z załącznikiem nr 1 do rozporządzenia Prezesa Rady Ministrów z dnia 18 stycznia 2011 r. w sprawie instrukcji kancelaryjnej, jednolitych rzeczowych wykazów akt oraz instrukcji w sprawie organizacji i zakresu działania archiwów zakładowych.
</li><br/><li>
Posiada Pani/Pan prawo do żądania od administratora dostępu do danych osobowych jej dotyczących, żądania ich sprostowania oraz ograniczenia przetwarzania.
</li><br/><li>
W przypadku gdy uzna Pani/Pan, iż przetwarzanie danych osobowych dotyczących Pani/Pana narusza ogólnego rozporządzenia o ochronie danych osobowych z dnia 27 kwietnia 2016 r.; ma Pani/Pan prawo do wniesienia skargi do Prezesa Urzędu Ochrony Danych Osobowych z siedzibą przy ul. Stawki 2, 00-193 Warszawa.
</li><br/><li>
Podanie danych osobowych w zakresie wymaganym przepisami prawa jest obligatoryjne.
</li><br/><li>
Pani/Pana dane nie będą przetwarzane w sposób zautomatyzowany, w tym również w formie profilowania.
</li>
</ul>
</div>
</xsl:for-each><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="border:none;width:70%;"><div style="width:100%;">
</div></td><td style="border:none;"><div style="width:100%;">
<xsl:for-each select="ds:Signature/ds:SignatureValue">
<div class="signature-description">
Dokument został podpisany, aby go zweryfikować należy użyć<br/>oprogramowania do weryfikacji podpisu<br/>Data złożenia podpisu:<div class="signature-date field">
<div class="field-value">
<xsl:choose>
<xsl:when test="string(../ds:Object/descendant::*[local-name() = 'SigningTime']) != ''">
<span class="field-text">
<xsl:value-of select="../ds:Object/descendant::*[local-name() = 'SigningTime']"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div><br/><div class="signature-bold">
Podpis elektroniczny
</div><br/>
</div>
</xsl:for-each>
</div></td>
</tr>
</table>
</div>
</body>
</html>
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<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start"/>.<span> </span>
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<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start"/>.<span> </span>
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<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+5"/>.<span> </span>
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