………………..…….....................................
(Place)				(date)

Urząd Lotnictwa Cywilnego
ul. Marcina Flisa 2
02-247 Warszawa
Power of attorney to collect the licence
I, the undersigned ………………………………………..…………………….………………………………………………….
(first name and last name)
PESEL number (or date of birth) …………………………………………………….……....................................
holder of ID document ……………………………………………………………...…………………………………………..
address ………………………………………….…………………........................................................................
hereby authorize Ms/Mr ………………………………………..……….……..……….……………………………………..
(first name and last name)
holder of ID document ……………….……………………………..……………………..…....................................
address …………………………………………………………………..…..…..........................................................
………………………………………………………………………………………………………………………………………………..
to collect ……………………………………………………………………...………………………………………………………..
(insert licence type and number, if known)
at the Civil Aviation Authority.

.....................…………………………………………
(handwritten signature of the person
granting the power of attorney)