5952
| ID | 5952 |
|---|
| Data | 2018-10-15 |
|---|
| Symbol | 2018/10/15/5952 |
|---|
| Instytucja | Urząd Gminy Buczkowice |
|---|
| Nazwa | Wniosek o dezaktywację konta na platformie eUrząd |
|---|
| Czy Aktualny | 1 |
|---|
Ustawy (1)
Pliki
Styl
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WN-2
</div><div>
Wniosek o dezaktywację konta na platformie eUrząd
</div>
</div><div class="section" style="border-bottom:none;">
<div class="title">
A. MIEJSCE SKŁADANIA WNIOSKU
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<strong>
<br/><span>
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<xsl:when test="string(inst:NazwaInstytucji) != ''">
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<xsl:when test="string(adr:Adres/adr:KodPocztowy) != ''">
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</span><span> </span><span>
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:Miejscowosc) != ''">
<xsl:value-of select="adr:Adres/adr:Miejscowosc"/>
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</span>,<span> </span><span> </span><span>
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<xsl:value-of select="adr:Adres/adr:Ulica"/>
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<xsl:value-of select="adr:Adres/adr:Budynek"/>
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</span><br/><xsl:if test="string(adr:Kontakt/adr:Telefon) != ''">
Tel:<span> </span><span>
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<xsl:value-of select="adr:Kontakt/adr:Telefon"/>
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<div class="title">
B. DANE OSOBY FIZYCZNEJ
</div>
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<div class="subtitle1">
B.1 DANE IDENTYFIKACYJNE
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<xsl:variable name="lp_start_0" select="1"/>
<div>
<xsl:for-each select="wnio:DaneDokumentu/str:Nadawcy/meta:Podmiot/oso:Osoba"> <table class="table-with-borders" style="width:100%;" cellpadding="0" cellspacing="0">
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<xsl:with-param name="lp_start" select="$lp_start_0"/>
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</div>Login ePuap</span></div>
<div class="field-value">
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<xsl:when test="string(../../../../wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Wnioskodawca/wnio:LoginEPuap) != ''">
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<xsl:value-of select="../../../../wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Wnioskodawca/wnio:LoginEPuap"/>
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<xsl:when test="string(adr:Kontakt/adr:Email) != ''">
<span class="field-text">
<xsl:value-of select="adr:Kontakt/adr:Email"/>
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<xsl:with-param name="lp_start" select="$lp_start_0"/>
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</div>PESEL</span></div>
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<xsl:when test="string(oso:IdOsoby/oso:PESEL) != ''">
<span class="field-text">
<xsl:value-of select="oso:IdOsoby/oso:PESEL"/>
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</div>
</div><div class="section" style="border-bottom:none;">
<div class="subtitle1">
B.2 ADRES ZAMIESZKANIA
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<xsl:variable name="lp_start_6" select="6"/>
<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%;">
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<xsl:with-param name="lp_start" select="$lp_start_6"/>
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<div class="field-value">
<span class="field-text">
<xsl:choose>
<xsl:when test="adr:Kraj='PL'">POLSKA</xsl:when>
<xsl:otherwise>☐</xsl:otherwise>
</xsl:choose>
</span>
</div>
</div></td><td style="width:34%;"><div class="field" style="width:100%;">
<div class="field-label"><div class="lp-value"> <xsl:call-template name="lp_tamplate_7">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
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<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>
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</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"><div class="lp-value"> <xsl:call-template name="lp_tamplate_8">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>Powiat</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Powiat) != ''">
<span class="field-text">
<xsl:value-of select="adr:Powiat"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td><td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><div class="lp-value"> <xsl:call-template name="lp_tamplate_9">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>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"><div class="lp-value"> <xsl:call-template name="lp_tamplate_10">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>Miejscowość</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Miejscowosc) != ''">
<span class="field-text">
<xsl:value-of select="adr:Miejscowosc"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:33%;"><div class="field" style="width:100%;">
<div class="field-label"><div class="lp-value"> <xsl:call-template name="lp_tamplate_11">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>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"><div class="lp-value"> <xsl:call-template name="lp_tamplate_12">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>Poczta</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Poczta) != ''">
<span class="field-text">
<xsl:value-of select="adr:Poczta"/>
</span>
</xsl:when>
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</div>
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</tr>
</table><table style="border:none;width:100%;" cellpadding="0" cellspacing="0">
<tr style="vertical-align: top;">
<td style="width:66%;"><div class="field" style="width:100%;">
<div class="field-label"><div class="lp-value"> <xsl:call-template name="lp_tamplate_13">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
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<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Ulica) != ''">
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<xsl:value-of select="adr:Ulica"/>
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<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>Nr domu</div>
<div class="full-width field-value">
<div class="full-width"> <xsl:choose>
<xsl:when test="string(adr:Budynek) != ''">
<span class="field-text">
<xsl:value-of select="adr:Budynek"/>
</span>
</xsl:when>
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</xsl:choose>
</div>
</div>
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<div class="field-label"><div class="lp-value"> <xsl:call-template name="lp_tamplate_15">
<xsl:with-param name="lp_start" select="$lp_start_6"/>
</xsl:call-template>
</div>Nr lokalu</div>
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<xsl:when test="string(adr:Lokal) != ''">
<span class="field-text">
<xsl:value-of select="adr:Lokal"/>
</span>
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<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</div>
</div>
</div></td>
</tr>
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</div><div class="section">
<div class="title">
Oświadczenie
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<span class="field-items">
<span class="radio-item">
<div class="radioChecker">
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<xsl:when test="wnio:TrescDokumentu/wnio:Deklaracje/wnio:Deklaracja/wnio:Oswiadczenie='T'">X</xsl:when>
<xsl:otherwise> </xsl:otherwise>
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</div>
Oświadczam, iż rezygnuję z doręczania pism za pomocą środków komunikacji elektronicznej zgodnie z art. 39¹ §1d Kodeksu postępowania administracyjnego (Dz. U. 2017 poz. 1257 ze zm.).
</span>
</span>
</div>
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<div class="title" style="border-bottom:none;">
Informacja
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<div class="wrap section" style="border-top:none;border-right:1px solid black;border-bottom:1px solid black;border-left:1px solid black;">
Zgodnie z art. 13 ust. 1 i ust. 2 rozporządzenia Parlamentu Europejskiego i Rady (UE) 2016/679 z 27 kwietnia 2016 r. w sprawie ochrony osób fizycznych w związku z przetwarzaniem danych osobowych i w sprawie swobodnego przepływu takich danych oraz uchylenia dyrektywy 95/46/WE (ogólne rozporządzenie o ochronie danych), informujemy, iż:<br/>
<ul>
<li>Administratorem Pani/Pana danych osobowych jest <strong>Wójt Gminy Buczkowice, z siedzibą przy
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:Ulica) != ''">
<xsl:value-of select="adr:Adres/adr:Ulica"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:Budynek) != ''">
<xsl:value-of select="adr:Adres/adr:Budynek"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
<xsl:if test="string(adr:Adres/adr:Lokal) != ''">
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:Lokal) != ''">
<xsl:value-of select="adr:Adres/adr:Lokal"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</xsl:if>,
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:KodPocztowy) != ''">
<xsl:value-of select="adr:Adres/adr:KodPocztowy"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
<xsl:choose>
<xsl:when test="string(adr:Adres/adr:Miejscowosc) != ''">
<xsl:value-of select="adr:Adres/adr:Miejscowosc"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>, telefon:
<xsl:choose>
<xsl:when test="string(adr:Kontakt/adr:Telefon) != ''">
<xsl:value-of select="adr:Kontakt/adr:Telefon"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>, e-mail:
<xsl:choose>
<xsl:when test="string(adr:Kontakt/adr:Email) != ''">
<xsl:value-of select="adr:Kontakt/adr:Email"/>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
</xsl:choose>
</strong>
</li>
<li>Administrator wyznaczył Inspektora Ochrony Danych, z którym może się Pani/Pan skontaktować w sprawach związanych z ochroną danych osobowych, pod adresem poczty elektronicznej: iod@buczkowice.pl lub pisemnie na adres siedziby Administratora,</li>
<li>Administrator powołuje się na prawnie uzasadniony interes, którym jest udostępnienie Pani/Panu informacji z rejestrów bazodanowych prowadzonych w Urzędzie dotyczących Pani/Pana danych,</li>
<li>Pani/Pana dane osobowe będą przechowywane do czasu funkcjonowania platformy eUrząd lub rezygnacji z konta na platformie eUrząd,</li>
<li>posiada Pani/Pan prawo dostępu do treści swoich danych osobowych, prawo do ich sprostowania, usunięcia, jak również prawo do ograniczenia ich przetwarzania/prawo do cofnięcia zgody, prawo do wniesienia sprzeciwu wobec przetwarzania Pani/Pana danych osobowych,</li>
<li>przysługuje Pani/Panu prawo wniesienia skargi do organu nadzorczego, którym jest Prezes Urzędu Ochrony Danych Osobowych, z siedzibą przy ul. Stawki 2, 00-913 Warszawa, jeśli Pani/Pana zdaniem, przetwarzanie danych osobowych Pani/Pana - narusza przepisy rozporządzenia,</li>
<li>podanie przez Panią/Pana danych osobowych jest warunkiem zawarcia umowy o utworzenie konta na platformie eUrząd. Brak podania danych osobowych będzie skutkował brakiem możliwości utworzenia konta na platformie eUrząd,</li>
<li>Pani/Pana dane osobowe nie będą przekazywane żadnym odbiorcom danych,</li>
<li>Pani/Pana dane osobowe nie będą przetwarzane w sposób zautomatyzowany i nie będą profilowane.</li>
</ul>
</div>
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<td style="border:none;width:70%;"><div style="width:100%;">
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<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">
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<xsl:when test="string(../ds:Object/descendant::*[local-name() = 'SigningTime']) != ''">
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<xsl:value-of select="../ds:Object/descendant::*[local-name() = 'SigningTime']"/>
</span>
</xsl:when>
<xsl:otherwise> </xsl:otherwise>
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</div>
</div><br/><div class="signature-bold">
Podpis elektroniczny
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</body>
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<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start"/>.<span> </span>
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<xsl:template name="lp_tamplate_2">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+1"/>.<span> </span>
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<xsl:template name="lp_tamplate_3">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+2"/>.<span> </span>
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<xsl:template name="lp_tamplate_4">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+3"/>.<span> </span>
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<xsl:template name="lp_tamplate_5">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+4"/>.<span> </span>
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<xsl:template name="lp_tamplate_6">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start"/>.<span> </span>
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<xsl:template name="lp_tamplate_7">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+1"/>.<span> </span>
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<xsl:template name="lp_tamplate_8">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+2"/>.<span> </span>
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<xsl:template name="lp_tamplate_9">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+3"/>.<span> </span>
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<xsl:template name="lp_tamplate_10">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+4"/>.<span> </span>
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<xsl:template name="lp_tamplate_11">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+5"/>.<span> </span>
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<xsl:template name="lp_tamplate_12">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+6"/>.<span> </span>
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<xsl:template name="lp_tamplate_13">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+7"/>.<span> </span>
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<xsl:template name="lp_tamplate_14">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+8"/>.<span> </span>
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<xsl:template name="lp_tamplate_15">
<xsl:param name="lp_start" select="1"/><xsl:value-of select="$lp_start+9"/>.<span> </span>
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