Name 1:  
Name 2:  
Father’s name:  
Mother’s name:  
Place of residence  
(according to the identity document):  
Address for service  
(in case it is different than as shown in  
the identity document):  
Series and number of identity document :  
Social Security Number (PESEL number):  
Tax Identification Number:  
Contact phone number:  
E-mail address:  
Marital status:  

In the case of marital property agreement or compulsory separation of property, kindly provide us with such information or provide the original document that has caused such a regime. If the activity is carried out in the course of business or as a part of civil partnership, please kindly indicate the name and the number in the register of business activity:  

Please indicate which notarial activity the personal data concerns and provide any other comments regarding the undertaken notarial activity (e.g., the type of contract, the subject matter of a contract, the number of land and mortgage register, the value / price, the method and date of payment, the date of issuing the subject matter of the contract, establishing the mortgage, the amount of mortgage):

* - required information

Please kindly note that sending the message (including the one containing personal data of the parties and concerning the subject matter and the type of notarial activity) to our e-mail address is tantamount to expressing your consent to the processing of personal data in order to perform notarial acts and carry out further correspondence via e-mail.