Załącznik nr 3 - INFORMACJA NIEJAWNA

Transkrypt

Załącznik nr 3 - INFORMACJA NIEJAWNA
!"#$$"%&'()*+&
,&-&,&&
./!0&121
!"#$%&'()&*)+
WZÓR
3456789:;9&6& 6<6494=;&>.7?= 9@A&98'43:;3&.6 836B68C
6&<BD7A:E&86F9&F&97B0&1G&'>B0&H&.<B&1&I3B0&9&3&J&'>B9FAK
..........................................................
&
LM"#N(O/+/PQ&"&R*)*&(S/T!UR!#$"*V
..........................................................
&
L/!$*O!#$"#&ST!#R("WX"/TOYV
..........................................................
&
L$ZM#T&%/$O#(N"V
..........................................................
..........................................................
..........................................................
&
L*RT#(*)&"$[/TM*ON"V
\0&
*)*&(ST!#R*]YKK^& ...............................................................................................................................................................
H0& 8"#N(O#&(ST!#R*]Y^& ..............................................................................................................................................................
,-.
/01%!23)&!%4!3)(!5'67*)!89&'$2'
:50;<
................................................................................
&
L"M"W&"&$*!+"(%/&ST!#R("WX"/TOY&R/%/$ZNUO#_/&(ST!#R*]YV&
K& '()*+*&!&R$"*&HH&O!#T+O*&HGG\&T0&/&+Y%/$Y+*$"Z&R!"*`*a$/PO"&_/(S/R*TO!#N&+&!*%T#("#&+Y)+*T!*$"*&"&/XT/)Z&M*)#T"*`*M"&+YXZOb/+YM"C&XT/$"UC&*MZ$"ONU&/T*!&+YT/X*M"&"&)#Ob$/a/_"U&/&ST!#!$*O!#$"Z&+/N(%/+YM&aZX&S/a"OYN$YM&L !0&'0&!&HG\H&T0&S/!0&\G\-V0
**&4*a#]Y&S/R*Q&%+*T)*`&"&T/%0