DzienniN Ustaw - 6 - Poz. 1860 INFORMACJE

DzienniN Ustaw - 6 - Poz. 1860 INFORMACJE

!"#$$"%&'()*+&
,&-&,&&
./!0&12-3
4*567!$"%"&8/&9/!:/9!68!#$"*&;"$"()9*&<"$*$(=+&
!&8$"*&>&?9@8$"*&A31B&90&C:/!0&12-3D
!"#$%&'()&*)+
EF<GH;IJKLM&KINEL&.GOEFELF&4IOELHIP&OFEGQLN&G&4OHGR&.G IRN'&G &RGOIHSO&E&'QT'U&
QNTI IFV&4I&.G;GJW&XHG NSO&NG;'FENIJKE&LYLNRHGFEJ4FLKM&
GHI4&Q.GQSZ&G.EQ'&FELNRSHVJ[&EF<GH;IJKE
10&
.*\()+/&7!5/$%/+(%"#M&8/&%)=9#?/&*89#(/+*$]&^#()&+$"/(#%0
A0&
J#_&!5/`#$"*&+$"/(%@&C$/+]&+$"/(#%a%/9#%)*D0
b0&
B0&
l0&
*$#&8/)]7!67#&+$"/(%@M&8/&%)=9#?/&/8$/("&("c&%/9#%)*d
1)
numer wniosku,
2)
data wniosku.
*$#&:/8e"/)@&@:9*+$"/$#?/&!&:*\()+&7!5/$%/+(%"7f&'$""&L@9/:#^(%"#^&C+$"/(%/8*+7]Dd
1D&
8*$#&"8#$)]g"%*7]^$#&:/8e"/)@&@:9*+$"/$#?/&,&$*!+"(%/&"&"e"c&_@h&:#5$*&$*!+*M
AD&
8/%5*8$]&*89#(&("#8!"h]&8!"*5*_$/i7"&?/(:/8*97!#^&:/8e"/)@&@:9*+$"/$#?/M
bD&
*89#(&#je*"_M
BD&
$@e#9&9#^#()9*7]^$]&kIR0
G(/h*&9#:9#!#$)@^67*&:/8e"/)&@:9*+$"/$]&!&:*\()+&7!5/$%/+(%"7f&'$""&L@9/:#^(%"#^1)d
1D&
$*!+"(%/&"&"e"cM
AD&
8/%5*8$]&*89#(&/(/h]&9#:9#!#$)@^67#^M
bD&
*89#(&#je*"_M
BD&
$@e#9&"8#$)]g"%*7]^$]0
-0&
G:"(&9/8!*^@&:9/+*8!/$#^&8!"*5*_$/i7"&+#85@?&7!+*9)#?/&:/!"/e@&%/8=+&FIJL&H#m0&AM&!?/8$"#&!&*9)0&A&@()0&1&_")0&8&
9/!:/9!68!#$"*&$9&12>baA33-2)M&$*&:/8()*+"#&*9)0&A&9/!:/9!68!#$"*&$9&n>aA31A3).
n0&
G%9#(M&8/&%)=9#?/&/8$/("&("c&+$"/(#%d
1D& /8&C8!"#\M&e"#("67M&9/%DM
AD& 8/&C8!"#\M&e"#("67M&9/%D0
20&
Q!7!#?=5]&8/)]7!67#&9*7f@$%@&h*$%/+#?/&:/8e"/)@&@:9*+$"/$#?/&!&:*\()+&7!5/$%/+(%"7f&'$""&L@9/:#^(%"#^M&$*&
%)=9]&e*&h]o&8/%/$*$]&!+9/)&:/8*)%@d
1D& $@e#9&EZIFM&/&%)=9]e&e/+*&+&:9!#:"(*7f&:9*+*&h*$%/+#?/M
AD& %/8&ZEJM&/&%)=9]e&e/+*&+&:9!#:"(*7f&:9*+*&h*$%/+#?/M
bD& +*_@)*&9*7f@$%@&h*$%/+#?/0
>0&
E$g/9e*7^#&8/)]7!67#&"e:/9)/+*$]7f&)/+*9=+d
1D& "e"c&"&$*!+"(%/a$*!+*&(:9!#8*+7]&)/+*9=+M
AD& *89#(&"&%9*^&(:9!#8*+7]&)/+*9=+M
bD& 8*)*&"&$@e#9&8/%@e#$)@&7#_$#?/M
& E$g/9e*7^#&:/8*^#&("cM&^#i_"&:/8*)$"%&@()*$/+"5&:#5$/e/7$"%*0
& H/!:/9!68!#$"#&COLD&$9&12>baA33-&.*9_*e#$)@&L@9/:#^(%"#?/&"&H*8]&!&8$"*&A3&?9@8$"*&A33-&90&+&(:9*+"#&()*)]()]7!$#^&%_*(]g"%*7^"&
8!"*5*_$/i7"&?/(:/8*97!#^&FIJL&H#m0&A&"&!e"#$"*^67#&9/!:/9!68!#$"#&H*8]&CLOUD&$9&b3bna>3&/9*!&$"#%)=9#&9/!:/9!68!#$"*&OL&
+&(:9*+"#&/%9#i_/$]7f&8!"#8!"$&()*)]()]7!$]7f&C !0&'9!0&'L&Y&b>b&!&b301A0A33-M&()90&1M&!&:=p$0&!e0D0
3)
& H/!:/9!68!#$"#&+]%/$*+7!#&N/e"(^"&C'LD&$9&n>aA31A&!&8$"*&b1&()]7!$"*&A31A&90&@()*$*+"*^67#&(!7!#?=5/+#&!*(*8]&+]%/$]+*$"*&
$"#%)=9]7f& :9!#:"(=+& 9/!:/9!68!#$"*& H*8]& C'LD& $9& >3BaA313& +& (:9*+"#& +(:=5:9*7]& *8e"$"()9*7]^$#^& /9*!& !+*_7!*$"*& /(!@()+&
+&8!"#8!"$"#&:/8*)%@&/8&+*9)/i7"&8/8*$#^&C !0&'9!0&'L&Y&A>&!&3103A0A31AM&()90&1bM&!&:=p$0&!e0D0
1)
2)
!"#$$"%&'()*+&
,&n&,&&
./!0&12-3
BD&
9/8!*^&)/+*9=+&+#85@?&%/8=+&"&:/8%/8=+M&/&%)=9]7f&e/+*&+&!*567!$"%@&8/&9/!:/9!68!#$"*&$9&n>aA31A3),
lD&
:/8()*+*&/:/8*)%/+*$"*&+&.YFM
-D&
%+/)*&:/8*)%@&+&.YFM
nD&
& h_"7!#$"#&:/8*)%@&+&:9!]:*8%@&()/(/+*$"*&:9/:/97^"M&/&%)=9#^&e/+*&+&*9)0&2>&@()0&1h&@()*+]&,&+](/%/io&:9//
:/97^"&C+&qDM
2D&
%+/)*&:/8*)%@&8/&!+9/)@&+&.YF4).
130& E$g/9e*7^#&8/)]7!67#&$*h])]7f&)/+*9=+&"&@(5@?d
1D&
"e"c&"&$*!+"(%/a$*!+*&8/()*+7]&)/+*9=+&_@h&@(5@?M
AD&
F@e#9&E8#$)]g"%*7^"&./8*)%/+#^&8/()*+7]&)/+*9=+&_@h&@(5@?M
bD&
*89#(&"&%9*^&8/()*+7]&)/+*9=+&_@h&@(5@?M
4)
data i numer faktury,
lD&
&9/8!*^&)/+*9=+&"&@(5@?&+#85@?&%/8=+&"&:/8%/8=+M&/&%)=9]7f&e/+*&+&!*567!$"%@&8/&9/!:/9!68!#$"*&$9&n>aA31A3),
-D&
:/8()*+*&/:/8*)%/+*$"*&+&.YFM
nD&
%+/)*&:/8*)%@&+&.YFM
2D&
& h_"7!#$"#&:/8*)%@&+&:9!]:*8%@&()/(/+*$"*&:9/:/97^"M&/&%)=9#^&e/+*&+&*9)0&2>&@()0&1h&@()*+]&,&+](/%/io&:9//
:/97^"&C+&qDM
>D&
%+/)*&:/8*)%@&8/&!+9/)@&+&.YF4).
110& 4e"*$*&:9/:/97^"M&/&%)=9#^&e/+*&+&*9)0&2>&@()0&1#&@()*+]d
1D& /%9#(M&8/&%)=9#?/&/8$/("&("c&!e"*$*d
*D&& /8&C8!"#\M&e"#("67M&9/%DM
hD&& 8/&C8!"#\M&e"#("67M&9/%DM
AD& +](/%/io&:9/:/97^"&:/&!e"*$"#&C+&qD0
1A0& E$g/9e*7^*&/&!*567!$"%*7f&,&)]:&"&$*!+*&:_"%@&/9*!&/:"(&!*+*9)/i7"0
4)
& O&:9!]:*8%@&()/(/+*$"*&:9/:/97^"M&/&%)=9#^&e/+*&+&*9)0&2>&@()0&1h&@()*+]M&%+/)*&!+9/)@&+"$$*&h]o&/h_"7!/$*&!&@+!?_c8$"#$"#e&)#^&
:9/:/97^"0