• Faithful to my Homeland, the Republic of Poland

  • Information on how to fill in the passport (or temporary passport) application form submitted to consul






    A passport applicant shall legibly fill in the form (only points from no. 1 to no. 14), providing data - in accordance with the legal status as of the day of submitting the application.


    Point no. 1 Enter the PESEL number. If the application concerns a person who does not have a PESEL number, the place should be left blank.


    Point no. 2 Please enter the current surname according to the legal status at the date of the application. If the application concerns a person who is applying for a passport exchange due to the change of surname, e.g. in connection with marriage, a new name should be given in this field.


    Point. No. 3 Enter your family name (the surname indicated in the Polish birth certificate) and other surnames if they have been changed.

    (The family name is commonly referred to in case of women as a maiden name).

    The requirement to enter surnames applies to every person for whom a passport or temporary passport is to be issued - that is: women, men, and minors.


    - a person who has been named Kowalski since birth and did not change his / her surname, gives data on this point: “rod. Kowalski; nie było zmiany nazwiska(Polish: family name Kowalski; there was no name change),

    - a person who has been named Nowak by birth and then after marriage – he / she was named Nowak-Michalak, after divorcing he / she has a surname – Nowak, gives data on this point: “rod. Nowak; poprzednie nazwisko – Nowak-Kowalska(Polish: family name Kowalski; previous name – Nowak-Kowalski).


    Point no. 4 Enter your first name(s) – according to the data contained in the Polish birth certificate.


    Point no. 5 Enter first names of both parents.


    Point no. 6 Enter the mother's family name (colloquially called “the maiden name”).


    Point no. 7 Enter the date of birth: the first two "boxes" should contain the digits indicating the day of birth,

    in the next two boxes – digits specifying the month, in the other four boxes – digits defining the year of birth.

    Abbreviations placed under the boxes in the imprint "data urodzenia: dd-mm-rrrr" shall mean:

    dd – day of birth, mm – month of birth, rrrr – year of birth.



    A person born on  1 March 1987 =    0    1  -  0      3    -   1     9       8     7              


    A person born on 23 November 1987  =     2    3  -   1     1    -   1     9       8      7         


    A person born on 5 September 2011 =    0    5  -   0     9    -   2     0      1      1        


    Point no. 8 Enter the name of the town where the person was born.


    Point no. 9 Address for correspondence abroad.

    Note: the person applying for a temporary passport to return to the place of permanent residence - enters the address of his / her permanent residence.

    A person with permanent residence in Poland – enters his / her address of place of permanent residence in Poland, a person who has permanent residence abroad enters his / her address of place of permanent residence abroad.


    Point no. 10 Telephone number or e-mail address – providing data is not mandatory.


    Point no. 11 Please check the correct box indicating the sex: “kobieta” – female, “mężczyzna” – male.


    Point no. 12 The signature is put only by a person who is over 13 years old. For people under the age of 13, the frame shall be left blank. This signature will be transferred into the passport (biometric).

    Note: the signature cannot touch or cross the frame.


    Point no. 13 The person submitting the application should read the content of the statement included in this item, then put his / her signature, enter the name of the town and enter the date.

    If an application is submitted for issuing a passport or a temporary passport for a minor (i.e. a person who is under 18 years old) – the signature is made by one of the parents (or both).


    The statement reads in Polish as follows:

    “If someone provides untrue information or conceals the truth in the application form, he or she will be subjected to punishment of imprisonment for 6 months to 8 years. I declare that I understand criminal responsibility for concealing the truth or providing untrue information in this application.

    I confirm with my signature that the above data is true. Legal basis: art. 233 § 1 in connection with § 6 of the Act of June 6, 1997 – the Penal Code”.


    Point. 14 Parents or (if applicable) guardians appointed by the court applying for the issuance of a passport or a temporary passport for a minor child shall put their signatures in the presence of an consulate’s clerk admitting the application.



    The person submitting the passport application does not fill in other points than from 1 to 14.

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