PESEL with the UKR status
Official PL/UKR form, with field captions in Polish and Ukrainian, for people from Ukraine under temporary protection. File it in person at any municipal office within 30 days of crossing the border. It is filled in only in Latin capital letters, not in Cyrillic; Polish letters such as Ą, Ł and Ż are allowed.
You get the official PDF with your answers in its boxes, ready to print and sign by hand.
About the form
- Official name
- Wniosek o nadanie numeru PESEL w związku z konfliktem na Ukrainie
- Published by
- Ministerstwo Cyfryzacji
- Form and legal basis
- PL/UKR wersja 8 · art. 44a ustawy o ewidencji ludności
- Pages
- 3
- Official source
- www.gov.pl
- Copy used here
- taken on 5 November 2026, checked against the source every day
The official blank
The same file as on the official source, to print and fill in by hand.
How to file it
What the law says about filing, each point with the passage it rests on. These sources are checked every day.
- File it in person at any municipal office (urząd gminy) in Poland, on paper, with your own legible signature.art. 110a ust. 1 ustawy o udzielaniu cudzoziemcom ochrony; art. 44a ust. 3 ustawy o ewidencji ludności
- File within 30 days of crossing the Polish border. Without an application in that time, temporary protection ends.art. 110a ust. 2, art. 109b ust. 1 pkt 1 ustawy o udzielaniu cudzoziemcom ochrony
- For a child, a parent, guardian, curator, temporary guardian or the person who actually cares for the child files it. The child must be present.art. 44a ust. 4, art. 44a ust. 5 ustawy o ewidencji ludności
- Attach a photo that meets the requirements for a Polish ID card photo.art. 44a ust. 9 ustawy o ewidencji ludności
- Bring a valid travel document (passport): the office confirms your identity from it.art. 44a ust. 13 ustawy o ewidencji ludności
- The office takes fingerprints when you file, except from children under 6.art. 44a ust. 10, art. 44a ust. 11 ustawy o ewidencji ludności
Updated on 6 November 2026. Rules and office practice change: check with your office yourself before you go.
What the form asks for
The questions in your language, as the site asks them. The printed form stays in Polish.
- Surname
- Given name(s)
- Date of birth
- Country of birth
- Citizenship: other
- Ukrainian record number (Запис №), first 8 digits
- Ukrainian record number (Запис №), last 5 digits
- Series and number of your valid travel document (passport)
- Father: surname
- Father: first given name
- Father: PESEL number (if assigned)
- Mother: surname
Show 16 more
- Mother: first given name
- Mother: PESEL number (if assigned)
- Date you entered Poland
- Date you entered the Schengen area
- Country where you entered the Schengen area
- Person caring for the child: surname
- Person caring for the child: given name(s)
- Person caring for the child: date of birth
- Person caring for the child: PESEL number (if assigned)
- Person caring for the child: citizenship
- Person caring for the child: document that proves identity
- Relation to the child: who you are to the child
- Phone number
- E-mail address
- Place
- Date
Example situations
Fictional people. When filling in the form, pick one to see a completed example, then replace the answers with yours.
Adult applies for herself
A woman who fled the war applies within 30 days of arrival and gives a phone number and e-mail for her Trusted Profile.
A child with her mother
A mother files for her 8-year-old daughter: the parents' data from the birth certificate and the mother as the person caring for the child.
A young man arriving alone
A 21-year-old who arrived alone applies for himself and gives only a mobile phone number for contact.
A Moldovan spouse via Romania
The Moldovan husband of a Ukrainian citizen left Ukraine through Romania, so he gives the country and date he entered the Schengen area.
A grandmother with her grandson
A grandmother who takes care of her 10-year-old grandson files for him as another person caring for the child.
A teenager and her aunt
An aunt appointed by a Polish court as temporary guardian files for her 15-year-old niece, who came without her parents.
This site is not connected to any office. The office decides on your case, so check with it which documents and attachments it needs before you go.
Other forms
- PESEL number application
- Temporary residence registration
- Permanent residence registration
- Temporary residence deregistration
- Permanent residence deregistration
- Residence card: new card or replacement
- Report a lost or damaged document
- Schengen visa extension
- National visa extension
- Register your stay as an EU citizen
- Notice of leaving Poland
- Notice of return to Poland
- Driving licence: apply or exchange
- Change of temporary residence and work permit
- Notice of job loss
- Polish travel document for a foreigner
- Invitation register application
- Temporary identity certificate for a foreigner (TZTC)