Form to be completed by employee only:

Name *

Surname *

PESEL *

I do not hold Universal Electronic System for Registration of the Population (PESEL) number

Sex *

FemaleMale

Date of birth *

Place of birth *

E-mail *

Telephone No. *

Proszę podać numer telefonu używając wyłącznie cyfr, bez spacji i myślników. Numer stacjonarny poprzedź numerem kierunkowym.

Zbiór pól 2


	*I declare that I have read the information on the processing of my Information from the personal data administrator provided to me.

	*I consent to the sending of information that relates to my insurance in PZU Życie S.A. by means of electronic communication, including SMS/MMS or e-mail, to the telephone number or e-mail address provided by me. In case of changes in the contact details provided by me, I undertake to update my details, thanks to which I will receive information via electronic means of communication.

	To the extent that the processing of your personal data is based on consent, you have the right to withdraw this consent. You can withdraw your consent at any time in the branch or by sending an e-mail to: kontakt@pzu.pl or a letter to PZU, ul. Postępu 18a, 02-676 Warszawa, Poland. The withdrawal of consent does not affect the legality of the processing carried out on the basis of consent before its withdrawal.

Wystąpił błąd podczas generowania wydruku. Proszę spróbuj ponownie.

Nie można wygenerować wydruku - element został usunięty.