If the answer is 2 or 3 - give the name of the country (ies) of citizenship

[] 1 Polish (only)
[] 2 Both - Polish and other (specify) ________
[] 3 Only others (specify)

________ Name of country
________ Name of country

1. An enumerated person can be a citizen of one, two or more countries.If a person is a citizen of more than one country, write in the names of maximum two countries. For stateless persons answer 3 should be chosen.

2. For persons being citizens of Poland only choose answer 1.

3. If a foreign person does not know the country he/she is a citizen of, write in the name of the country he/she was born in.