APPLICATION FOR THE PERMANENT RESIDENCE PERMIT

The application should be filled in Polish language

Application to  info_outline
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A. PERSONAL DATA OF THE FOREIGNER

1. Surname  info_outline
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2. Previous surname(s)  info_outline
2. Previous surname(s)  info_outline
3. Family name  info_outline
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4. Name(s)  info_outline
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5. Previous name(s)  info_outline
5. Previous name(s)  info_outline
6. Father's name  info_outline
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7. Mother's name  info_outline
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8. Mother's maiden name  info_outline
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9. Date of birth  info_outline
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10. Sex  info_outline
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11. Place of birth  info_outline
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12. Country of birth  info_outline
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13. Nationality  info_outline
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14. Citizenship  info_outline
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15. Marital status  info_outline
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16. Education  info_outline
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17. Practised profession  info_outline
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18. Description 
info_outline
Height  info_outline
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Colour of eyes  info_outline
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Special marks  info_outline
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19. PESEL number (if granted)  info_outline
20. Phone Number  info_outline

B. TRAVEL DOCUMENT OF THE FOREIGNER

Document's series  info_outline
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Document's number  info_outline
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Document's date of issue  info_outline
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Document's expiry date  info_outline
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Document's issuing authority  info_outline
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Number of other persons entered in the travel document  info_outline
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C. PLACE OF RESIDENCE OF THE FOREIGNER

1. Voivodship  info_outline
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2. District  info_outline
* field is required
3. Municipality  info_outline
* field is required
4. City  info_outline
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5. Street  info_outline
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6. Home number  info_outline
* field is required
7. Apartment number  info_outline
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8. Postal code  info_outline
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D. ADDITIONAL INFORMATION

I. Date of the spouse

1. Surname  info_outline
* field is required
2. Name(s)  info_outline
2. Name(s)  info_outline
* field is required
3. Previous name(s)  info_outline
3. Previous name(s)  info_outline
4. Previous surname(s)  info_outline
4. Previous surname(s)  info_outline
5. Date of birth  info_outline
* field is required
6. Sex  info_outline
* field is required
7. Citizenship  info_outline
* field is required
8. Place of residence 
info_outline
City  info_outline
* field is required
Street  info_outline
* field is required
Home number  info_outline
* field is required
Apartment number  info_outline
* field is required
Postal code  info_outline
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Country  info_outline
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II. Foreigner’s stay on the territory of the Republic of Poland

a) previous stays on the territory of the Republic of Poland 
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b) current stay on the territory of the Republic of Poland
1. Are you staying in the territory of the Republic of Poland?  info_outline
2. What is the date of your last entry into the territory of the Republic of Poland?   info_outline
3. What is the purpose of your stay?  info_outline
4. What are the grounds of your stay?  info_outline
Type of visa  info_outline
Visa serie  info_outline
Visa number  info_outline
Visa date of issue  info_outline
Visa expiry date  info_outline
Period of stay  info_outline
Visa issuing authority  info_outline
Decision issuing authority  info_outline
Decision date of issue  info_outline
Residence card or document entitling to entry and stay
Document serie  info_outline
Document number  info_outline
Document date of issue  info_outline
Document expiry date  info_outline
Document issuing authority  info_outline

III. Foreigner’s travels and stays outside the territory of the Republic of Poland in the last 5 years (country, period of stay)

IV. Have you been held in custody, placed in a guarded centre or detention facility for foreigners, or has a preventive measure been applied against you in the form of prohibition to leave the country, or have you been deprived of liberty or temporarily detained?

V. Have you been sentenced by the courts in the territory of the Republic of Poland?  info_outline
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When, for what act, what was the sentence and whether it was executed? 
VI. Are any penal proceedings or minor offence proceedings under way against you in the territory of the Republic of Poland?  info_outline
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What? 
VII. Do you comply with fiscal obligations to the state treasury?  info_outline
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F. JUSTIFICATION OF THE APPLICATION  info_outline
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Annexes to the application  info_outline