{"id":1731,"date":"2025-10-09T14:25:28","date_gmt":"2025-10-09T12:25:28","guid":{"rendered":"https:\/\/kvg-bus.de\/cuxhaven\/?page_id=1731"},"modified":"2025-10-30T09:29:35","modified_gmt":"2025-10-30T08:29:35","slug":"zaspokajanie-roszczen","status":"publish","type":"page","link":"https:\/\/kvg-bus.de\/cuxhaven\/pl\/usluga\/zaspokajanie-roszczen\/","title":{"rendered":"Rozliczanie roszcze\u0144"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1731\" class=\"elementor elementor-1731\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a526900 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a526900\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-f440ebf\" data-id=\"f440ebf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-52360c1 elementor-widget elementor-widget-heading\" data-id=\"52360c1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">ZASPOKAJANIE ROSZCZE\u0143 Z TYTU\u0141U WYPADK\u00d3W<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5c477a5 elementor-widget elementor-widget-text-editor\" data-id=\"5c477a5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Je\u015bli bilet MobilityTicket zostanie zgubiony lub uszkodzony, mo\u017cna \u0142atwo z\u0142o\u017cy\u0107 wniosek o jego wymian\u0119 tutaj.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-163b554 elementor-hidden-mobile\" data-id=\"163b554\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-3056fb1 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"3056fb1\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cd54882 elementor-widget elementor-widget-text-editor\" data-id=\"cd54882\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Je\u015bli mia\u0142e\u015b wypadek z KVG, skontaktuj si\u0119 z nami przed podj\u0119ciem jakichkolwiek dalszych krok\u00f3w. Mo\u017cesz pobra\u0107 kwestionariusz dla wnioskodawc\u00f3w\u00a0<a href=\"#OnlineformularSchadenabwicklung\">online<\/a><a href=\"#PDFSchadenabwicklung\"> wype\u0142nienie<\/a> lub jako <a href=\"#PDFSchadenabwicklung\">Pobierz PDF.<\/a> Prosimy o do\u0142\u0105czenie do listu wszystkich istotnych informacji i dokument\u00f3w dotycz\u0105cych wypadku (np. zdj\u0119\u0107, zezna\u0144 \u015bwiadk\u00f3w, raportu policyjnego), aby\u015bmy mogli jak najszybciej rozpatrzy\u0107 wniosek.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2c87fee elementor-widget elementor-widget-spacer\" data-id=\"2c87fee\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f14cf25 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"f14cf25\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-249c11f elementor-widget elementor-widget-menu-anchor\" data-id=\"249c11f\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"OnlineformularSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9aac4fd elementor-widget elementor-widget-heading\" data-id=\"9aac4fd\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Kwestionariusz dla wnioskodawc\u00f3w <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-71336f7 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"71336f7\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_22' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\" oznacza pola wymagane<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_22'  action='\/cuxhaven\/pl\/wp-json\/wp\/v2\/pages\/1731' data-formid='22' novalidate data-trp-original-action=\"\/cuxhaven\/pl\/wp-json\/wp\/v2\/pages\/1731\">\n                        <div class='gform-body gform_body'><div id='gform_fields_22' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_22_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Dane osobowe<\/h3><\/div><div id=\"field_22_3\" class=\"gfield gfield--type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_3'>Pozdrowienie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_22_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Pan<\/option><option value='Frau' >Pani<\/option><option value='Keine Angabe' >Nie okre\u015blono<\/option><\/select><\/div><\/div><fieldset id=\"field_22_5\" class=\"gfield gfield--type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nazwa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_5'>\n                            \n                            <span id='input_22_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_22_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_5_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_22_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_5_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_22_12\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_12'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_22_12' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_13\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_13'>e-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_22_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_22_6\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_22_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_6_1' id='input_22_6_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_22_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_6_3' id='input_22_6_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_22_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_22_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_6_5' id='input_22_6_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_6_6_container' >\n                                        <select name='input_6.6' id='input_22_6_6'   aria-required='true'    ><option value='' ><\/option><option value='Afganistan' >Afganistan<\/option><option value='Albania' >Albania<\/option><option value='Algieria' >Algieria<\/option><option value='Andora' >Andora<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktyda' >Grobla antarktyczna<\/option><option value='Antigua i Barbuda' >Antigua i Barbuda<\/option><option value='Arabia Saudyjska' >Arabia Saudyjska<\/option><option value='Argentyna' >Argentyna<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbejd\u017can' >Azerbejd\u017can<\/option><option value='Bahamy' >Bahamy<\/option><option value='Bahrajn' >Bahrajn<\/option><option value='Bangladesz' >Bangladesz<\/option><option value='Barbados' >Barbados<\/option><option value='Belgia' >Belgia<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermudy' >Bermudy<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bia\u0142oru\u015b' >Bia\u0142oru\u015b<\/option><option value='Boliwia' >Boliwia<\/option><option value='Bonaire, St Eustatius i Saba' >Bonaire, St Eustatius i Saba<\/option><option value='Botswana' >Botswana<\/option><option value='Bo\u015bnia i Hercegowina' >Bo\u015bnia i Hercegowina<\/option><option value='Brazylia' >Brazylia<\/option><option value='Brunei Darussalam' >Pa\u0144stwo Brunei Darussalam<\/option><option value='Brytyjskie Terytorium Oceanu Indyjskiego' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Bu\u0142garia' >Bu\u0142garia<\/option><option value='Chile' >Chile<\/option><option value='Chiny' >Chiny<\/option><option value='Chorwacja' >Chorwacja<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cypr' >Cypr<\/option><option value='Czad' >Czad<\/option><option value='Czarnog\u00f3ra' >Czarnog\u00f3ra<\/option><option value='Czechy' >Czechy<\/option><option value='Dania' >Dania<\/option><option value='Demokratyczna Republika Kongo' >Demokratyczna Republika Konga<\/option><option value='Dominikana' >Dominicana<\/option><option value='Dominikana, Republika' >Dominikana, Republika<\/option><option value='D\u017cibuti' >D\u017cibuti<\/option><option value='Egipt' >Egipt<\/option><option value='Ekwador' >Ekwador<\/option><option value='Erytrea' >Erytrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Suazi)' >Eswatini (Suazi)<\/option><option value='Etiopia' >Etiopia<\/option><option value='Falklandy' >Falklandy<\/option><option value='Federacja Rosyjska' >Federacja Rosyjska<\/option><option value='Fid\u017ci' >Fid\u017ci<\/option><option value='Filipiny' >Filipiny<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francja' >Francja<\/option><option value='Francuskie Terytoria Po\u0142udniowe' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grecja' >Grecja<\/option><option value='Grenada' >Grenada<\/option><option value='Grenlandia' >Grenlandia<\/option><option value='Gruzja' >Gruzja<\/option><option value='Guam' >Guam<\/option><option value='Guernsey' >Guernsey<\/option><option value='Gujana' >Gujana<\/option><option value='Gujana Francuska' >Gujana Francuska<\/option><option value='Gwadelupa' >Gwadelupa<\/option><option value='Gwatemala' >Gwatemala<\/option><option value='Gwinea' >Gwinea<\/option><option value='Gwinea Bissau' >Gwinea Bissau<\/option><option value='Gwinea R\u00f3wnikowa' >Gwinea R\u00f3wnikowa<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Wyspa Heard i Wyspy McDonalda<\/option><option value='Hiszpania' >Hiszpania<\/option><option value='Holandia' >Holandia<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indie' >Indie<\/option><option value='Indonezja' >Indonezja<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlandia' >Irlandia<\/option><option value='Islandia' >Islandia<\/option><option value='Izrael' >Izrael<\/option><option value='Jamajka' >Jamajka<\/option><option value='Japonia' >Japonia<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordania' >Jordania<\/option><option value='Kajmany' >Kajmany<\/option><option value='Kambod\u017ca' >Kambod\u017ca<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Katar' >Katar<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kolumbia' >Kolumbia<\/option><option value='Komory' >Comory<\/option><option value='Kongo' >Kongo<\/option><option value='Korea Po\u0142udniowa' >Korea Po\u0142udniowa<\/option><option value='Korea\u0144ska Republika Ludowo-Demokratyczna' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Kostaryka' >Kostaryka<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwejt' >Kuwejt<\/option><option value='Laota\u0144ska Republika Ludowo-Demokratyczna' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libia' >Libia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litwa' >Litwa<\/option><option value='Luksemburg' >Luksemburg<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Majotta' >Majotta<\/option><option value='Makau' >Makau<\/option><option value='Malawi' >Malawi<\/option><option value='Malediwy' >Maledivy<\/option><option value='Malezja' >Malezja<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Mariany P\u00f3\u0142nocne' >Mariany P\u00f3\u0142nocne<\/option><option value='Maroko' >Maroco<\/option><option value='Martynika' >Martynika<\/option><option value='Mauretania' >Mauretania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Meksyk' >Meksyk<\/option><option value='Mikronezja' >Mikronezja<\/option><option value='Mjanma' >Mjanma<\/option><option value='Monako' >Monako<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambik' >Mozambik<\/option><option value='Mo\u0142dawia' >Mo\u0142dawia<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Niemcy' >Niemcy<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Nikaragua' >Nikaragua<\/option><option value='Niue' >Niue<\/option><option value='Norwegia' >Norwegia<\/option><option value='Nowa Kaledonia' >Nowa Kaledonia<\/option><option value='Nowa Zelandia' >Nowa Zelandia<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestyna' >Palestyna<\/option><option value='Panama' >Panama<\/option><option value='Papua Nowa Gwinea' >Papua Nowa Gwinea<\/option><option value='Paragwaj' >Paragwaj<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinezja Francuska' >Polinezja Francuska<\/option><option value='Polska' >Polska<\/option><option value='Portoryko' >Portoryko<\/option><option value='Portugalia' >Portugalia<\/option><option value='Po\u0142udniowa Afryka' >Po\u0142udniowa Afryka<\/option><option value='P\u00f3\u0142nocna Macedonia' >Macedonia P\u00f3\u0142nocna<\/option><option value='Republika Afryki \u015arodkowej' >Republika Afryki \u015arodkowej<\/option><option value='Republika Zielonego Przyl\u0105dka' >Republika Zielonego Przyl\u0105dka<\/option><option value='Reunion' >Reunion<\/option><option value='Rumunia' >Rumunia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Sahara Zachodnia' >Sahara Zachodnia<\/option><option value='Saint Kitts i Nevis' >Saint Kitts i Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Pierre i Miquelon' >Saint-Pierre i Miquelon<\/option><option value='Saint Vincent i Grenadyny' >Saint Vincent i Grenadyny<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Martin' >Saint-Martin<\/option><option value='Salwador' >Salwador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Ameryka\u0144ska' >Samoa Ameryka\u0144ska<\/option><option value='San Marino' >San Marino<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seszele' >Sesceles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='South Georgia and the South Sandwich Islands' >Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowy<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Stany Zjednoczone' >Stany Zjednoczone<\/option><option value='Stolica Apostolska' >Stolica Apostolska<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan Po\u0142udniowy' >Sudan Po\u0142udniowy<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard i Jan Mayen' >Svalbard i Jan Mayen<\/option><option value='Syryjska Republika Arabska' >Syryjska Republika Arabska<\/option><option value='Szwajcaria' >Szwajcaria<\/option><option value='Szwecja' >Szwecja<\/option><option value='S\u0142owacja' >S\u0142owacja<\/option><option value='S\u0142owenia' >S\u0142owenia<\/option><option value='Tad\u017cykistan' >Tad\u017cykistan<\/option><option value='Tajlandia' >Tajlandia<\/option><option value='Tajwan' >Tajwan<\/option><option value='Tanzania, Zjednoczona Republika' >Tanzania, Zjednoczona Republika<\/option><option value='Timor-Leste' >Timor Wschodni<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trynidad i Tobago' >Trynidad i Tobago<\/option><option value='Tunezja' >Tunezja<\/option><option value='Turcja' >Turcja<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >Mniejsze Wyspy Zewn\u0119trzne Stan\u00f3w Zjednoczonych<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraina' >Ukraina<\/option><option value='Urugwaj' >Urugwaj<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Wallis i Futuna' >Wallis i Futuna<\/option><option value='Wenezuela' >Wenezuela<\/option><option value='Wietnam' >Wietnam<\/option><option value='Wybrze\u017ce Ko\u015bci S\u0142oniowej' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='Wyspa Bo\u017cego Narodzenia' >Wyspa Bo\u017cego Narodzenia<\/option><option value='Wyspa Man' >Wyspa Man<\/option><option value='Wyspa Norfolk' >Wyspa Norfolk<\/option><option value='Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='Wyspy Alandzkie' >Wyspy Alandzkie<\/option><option value='Wyspy Bouvet' >Wyspy Bouveta<\/option><option value='Wyspy Cooka' >Wyspy Cooka<\/option><option value='Wyspy Dziewicze, U.S.A.' >Wyspy Dziewicze, USA.<\/option><option value='Wyspy Dziewicze, Wielka Brytania' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='Wyspy Kokosowe' >Wyspy Kokosowe<\/option><option value='Wyspy Marshalla' >Wyspy Marshalla<\/option><option value='Wyspy Owcze' >Wyspy Owcze<\/option><option value='Wyspy Salomona' >Wyspy Salomona<\/option><option value='Wyspy Turks i Caicos' >Wyspy Turks i Caicos<\/option><option value='Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='W\u0119gry' >W\u0119gry<\/option><option value='W\u0142ochy' >W\u0142ochy<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zjednoczone Emiraty Arabskie' >Zjednoczone Emiraty Arabskie<\/option><option value='Zjednoczone Kr\u00f3lestwo' >Zjednoczone Kr\u00f3lestwo<\/option><option value='\u0141otwa' >\u0141otwa<\/option><\/select>\n                                        <label for='input_22_6_6' id='input_22_6_6_label' class='gform-field-label gform-field-label--type-sub'>Kraj<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Szczeg\u00f3\u0142y wypadku<\/h3><\/div><div id=\"field_22_14\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_14'>Miejsce<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_22_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_11\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >data<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_22_11' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_22_11_2_container'><label for='input_22_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Dzie\u0144<\/label><select name='input_11[]' id='input_22_11_2'   aria-required='true'  ><option value=''>Dzie\u0144<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_22_11_1_container'><label for='input_22_11_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>miesi\u0105c<\/label><select name='input_11[]' id='input_22_11_1'   aria-required='true'  ><option value=''>miesi\u0105c<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_22_11_3_container'><label for='input_22_11_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Rok<\/label><select name='input_11[]' id='input_22_11_3'   aria-required='true'  ><option value=''>Rok<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_22_10\" class=\"gfield gfield--type-time gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Czas<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_22_10'>\n                            <input type='number' name='input_10[]' id='input_22_10_1' value=''  min='0' max='24' step='1'  placeholder='GG' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_22_10_1'>Godziny<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_10[]' id='input_22_10_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_22_10_2'>Minut(y)<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_22_67\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_67'>Droga\/skrzy\u017cowanie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_22_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_68\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_68'>Numer linii\/podr\u00f3\u017cy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_22_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_71\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_71'>Przystanek autobusowy<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_22_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_69\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_69'>Tablica rejestracyjna autobusu<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_22_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_70\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_70'>Imi\u0119 i nazwisko kierowcy<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_22_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_48\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_48'>Opis wypadku<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_22_48' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_22_76\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_22_76'>Plik<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_22_76' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_22_76&quot;,&quot;container&quot;:&quot;gform_multifile_upload_22_76&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_22_76&quot;,&quot;filelist&quot;:&quot;gform_preview_22_76&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/cuxhaven\\\/?gf_page=e39fd3a7eb4da38&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/cuxhaven\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/cuxhaven\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Akceptowane pliki&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;33554432b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:22,&quot;field_id&quot;:76,&quot;_gform_file_upload_nonce_22_76&quot;:&quot;8be3b40996&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_22_76&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_22_76' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Upu\u015b\u0107 pliki tutaj lub <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_22_76' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_22_76\"  >Wybierz pliki<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_22_76'>Maks. rozmiar pliku: 32 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_22_76'><\/ul> <div id='gform_preview_22_76' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_22_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">\u015awiadkowie<\/h3><\/div><fieldset id=\"field_22_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy s\u0105 jacy\u015b \u015bwiadkowie?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_81'>\n\t\t\t<div class='gchoice gchoice_22_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Ja'  id='choice_22_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_81_0' id='label_22_81_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Nein'  id='choice_22_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_81_1' id='label_22_81_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_20\" class=\"gfield gfield--type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nazwa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_20'>\n                            \n                            <span id='input_22_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_22_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_20_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_22_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_20_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_17\" class=\"gfield gfield--type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_22_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_17_1' id='input_22_17_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_22_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_17_3' id='input_22_17_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_22_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_22_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_17_5' id='input_22_17_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_22_17_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_21\" class=\"gfield gfield--type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_21'>Telefon<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_22_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy s\u0105 inni \u015bwiadkowie?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_80'>\n\t\t\t<div class='gchoice gchoice_22_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Ja'  id='choice_22_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_80_0' id='label_22_80_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Nein'  id='choice_22_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_80_1' id='label_22_80_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_24\" class=\"gfield gfield--type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nazwa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_24'>\n                            \n                            <span id='input_22_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_22_24_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_24_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_22_24_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_24_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_25\" class=\"gfield gfield--type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_25_1_container' >\n                                        <input type='text' name='input_25.1' id='input_22_25_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_25_1' id='input_22_25_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_25_3_container' >\n                                    <input type='text' name='input_25.3' id='input_22_25_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_25_3' id='input_22_25_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_25.4' id='input_22_25_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_25_5_container' >\n                                    <input type='text' name='input_25.5' id='input_22_25_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_25_5' id='input_22_25_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_25.6' id='input_22_25_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_26\" class=\"gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_26'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_22_26' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_27\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Nagranie policyjne<\/h3><\/div><div id=\"field_22_28\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_28'>Biuro<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_22_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_82\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_82'>Numer transakcji<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_22_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_30\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_30_1_container' >\n                                        <input type='text' name='input_30.1' id='input_22_30_1' value=''    aria-required='false'    \/>\n                                        <label for='input_22_30_1' id='input_22_30_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_22_30_3' value=''    aria-required='false'    \/>\n                                    <label for='input_22_30_3' id='input_22_30_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_30.4' id='input_22_30_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_30_5_container' >\n                                    <input type='text' name='input_30.5' id='input_22_30_5' value=''    aria-required='false'    \/>\n                                    <label for='input_22_30_5' id='input_22_30_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_22_30_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_77\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_77'>Plik<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_77' id='input_22_77' type='file' class='large' aria-describedby=\"gfield_upload_rules_22_77\" onchange='javascript:gformValidateFileSize( this, 33554432 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_22_77'>Maks. rozmiar pliku: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_22_77'><\/div> <\/div><\/div><div id=\"field_22_31\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Szkody materialne<\/h3><\/div><fieldset id=\"field_22_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy dosz\u0142o do uszkodzenia mienia?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_72'>\n\t\t\t<div class='gchoice gchoice_22_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Ja'  id='choice_22_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_72_0' id='label_22_72_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Nein'  id='choice_22_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_72_1' id='label_22_72_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_32\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_32'>Co zosta\u0142o uszkodzone?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_22_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_33\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >W\u0142a\u015bciciel (ewentualnie leasingodawca)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_33'>\n                            \n                            <span id='input_22_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.3' id='input_22_33_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_33_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.6' id='input_22_33_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_33_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Uprawniony do odliczenia podatku naliczonego?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_34'>\n\t\t\t<div class='gchoice gchoice_22_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Ja'  id='choice_22_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_34_0' id='label_22_34_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Nein'  id='choice_22_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_34_1' id='label_22_34_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_35\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Uszkodzenia pojazd\u00f3w silnikowych - samochod\u00f3w osobowych, ci\u0119\u017carowych itp.<\/h3><\/div><fieldset id=\"field_22_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy dosz\u0142o do uszkodzenia pojazdu silnikowego?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_73'>\n\t\t\t<div class='gchoice gchoice_22_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Ja'  id='choice_22_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_73_0' id='label_22_73_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Nein'  id='choice_22_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_73_1' id='label_22_73_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_36\" class=\"gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_36'>Rodzaj<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_22_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='PKW (Auto)' >Samoch\u00f3d<\/option><option value='Nutzfahrzeuge (LKW)' >Pojazdy u\u017cytkowe (ci\u0119\u017car\u00f3wki)<\/option><option value='Zweirad (Roller, Motorrad)' >Pojazd dwuko\u0142owy (skuter, motocykl)<\/option><option value='Land-\/ Baumaschinen' >Maszyny rolnicze\/budowlane<\/option><option value='Wohnmobil\/Wohnwagen' >Kamper\/przyczepa kempingowa<\/option><\/select><\/div><\/div><div id=\"field_22_37\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_37'>Producent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_22_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_38\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_38'>Typ<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_22_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_39\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_39'>Oficjalny numer rejestracyjny<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_22_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_40\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_40'>ubezpieczenie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_22_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_41\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Uraz cia\u0142a<\/h3><\/div><fieldset id=\"field_22_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy s\u0105 jakie\u015b obra\u017cenia cia\u0142a?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_74'>\n\t\t\t<div class='gchoice gchoice_22_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Ja'  id='choice_22_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_74_0' id='label_22_74_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Nein'  id='choice_22_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_74_1' id='label_22_74_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_42\" class=\"gfield gfield--type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_42'>Pozdrowienie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_22_42' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Pan<\/option><option value='Frau' >Pani<\/option><option value='Keine Angabe' >Nie okre\u015blono<\/option><\/select><\/div><\/div><fieldset id=\"field_22_43\" class=\"gfield gfield--type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nazwa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_43'>\n                            \n                            <span id='input_22_43_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.3' id='input_22_43_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_43_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_43_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.6' id='input_22_43_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_43_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_44\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_44' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_44_1_container' >\n                                        <input type='text' name='input_44.1' id='input_22_44_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_44_1' id='input_22_44_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_44_3_container' >\n                                    <input type='text' name='input_44.3' id='input_22_44_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_44_3' id='input_22_44_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_44.4' id='input_22_44_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_44_5_container' >\n                                    <input type='text' name='input_44.5' id='input_22_44_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_44_5' id='input_22_44_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_44_6_container' >\n                                        <select name='input_44.6' id='input_22_44_6'   aria-required='true'    ><option value='' ><\/option><option value='Afganistan' >Afganistan<\/option><option value='Albania' >Albania<\/option><option value='Algieria' >Algieria<\/option><option value='Andora' >Andora<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktyda' >Grobla antarktyczna<\/option><option value='Antigua i Barbuda' >Antigua i Barbuda<\/option><option value='Arabia Saudyjska' >Arabia Saudyjska<\/option><option value='Argentyna' >Argentyna<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbejd\u017can' >Azerbejd\u017can<\/option><option value='Bahamy' >Bahamy<\/option><option value='Bahrajn' >Bahrajn<\/option><option value='Bangladesz' >Bangladesz<\/option><option value='Barbados' >Barbados<\/option><option value='Belgia' >Belgia<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermudy' >Bermudy<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bia\u0142oru\u015b' >Bia\u0142oru\u015b<\/option><option value='Boliwia' >Boliwia<\/option><option value='Bonaire, St Eustatius i Saba' >Bonaire, St Eustatius i Saba<\/option><option value='Botswana' >Botswana<\/option><option value='Bo\u015bnia i Hercegowina' >Bo\u015bnia i Hercegowina<\/option><option value='Brazylia' >Brazylia<\/option><option value='Brunei Darussalam' >Pa\u0144stwo Brunei Darussalam<\/option><option value='Brytyjskie Terytorium Oceanu Indyjskiego' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Bu\u0142garia' >Bu\u0142garia<\/option><option value='Chile' >Chile<\/option><option value='Chiny' >Chiny<\/option><option value='Chorwacja' >Chorwacja<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cypr' >Cypr<\/option><option value='Czad' >Czad<\/option><option value='Czarnog\u00f3ra' >Czarnog\u00f3ra<\/option><option value='Czechy' >Czechy<\/option><option value='Dania' >Dania<\/option><option value='Demokratyczna Republika Kongo' >Demokratyczna Republika Konga<\/option><option value='Dominikana' >Dominicana<\/option><option value='Dominikana, Republika' >Dominikana, Republika<\/option><option value='D\u017cibuti' >D\u017cibuti<\/option><option value='Egipt' >Egipt<\/option><option value='Ekwador' >Ekwador<\/option><option value='Erytrea' >Erytrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Suazi)' >Eswatini (Suazi)<\/option><option value='Etiopia' >Etiopia<\/option><option value='Falklandy' >Falklandy<\/option><option value='Federacja Rosyjska' >Federacja Rosyjska<\/option><option value='Fid\u017ci' >Fid\u017ci<\/option><option value='Filipiny' >Filipiny<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francja' >Francja<\/option><option value='Francuskie Terytoria Po\u0142udniowe' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grecja' >Grecja<\/option><option value='Grenada' >Grenada<\/option><option value='Grenlandia' >Grenlandia<\/option><option value='Gruzja' >Gruzja<\/option><option value='Guam' >Guam<\/option><option value='Guernsey' >Guernsey<\/option><option value='Gujana' >Gujana<\/option><option value='Gujana Francuska' >Gujana Francuska<\/option><option value='Gwadelupa' >Gwadelupa<\/option><option value='Gwatemala' >Gwatemala<\/option><option value='Gwinea' >Gwinea<\/option><option value='Gwinea Bissau' >Gwinea Bissau<\/option><option value='Gwinea R\u00f3wnikowa' >Gwinea R\u00f3wnikowa<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Wyspa Heard i Wyspy McDonalda<\/option><option value='Hiszpania' >Hiszpania<\/option><option value='Holandia' >Holandia<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indie' >Indie<\/option><option value='Indonezja' >Indonezja<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlandia' >Irlandia<\/option><option value='Islandia' >Islandia<\/option><option value='Izrael' >Izrael<\/option><option value='Jamajka' >Jamajka<\/option><option value='Japonia' >Japonia<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordania' >Jordania<\/option><option value='Kajmany' >Kajmany<\/option><option value='Kambod\u017ca' >Kambod\u017ca<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Katar' >Katar<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kolumbia' >Kolumbia<\/option><option value='Komory' >Comory<\/option><option value='Kongo' >Kongo<\/option><option value='Korea Po\u0142udniowa' >Korea Po\u0142udniowa<\/option><option value='Korea\u0144ska Republika Ludowo-Demokratyczna' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Kostaryka' >Kostaryka<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwejt' >Kuwejt<\/option><option value='Laota\u0144ska Republika Ludowo-Demokratyczna' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libia' >Libia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litwa' >Litwa<\/option><option value='Luksemburg' >Luksemburg<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Majotta' >Majotta<\/option><option value='Makau' >Makau<\/option><option value='Malawi' >Malawi<\/option><option value='Malediwy' >Maledivy<\/option><option value='Malezja' >Malezja<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Mariany P\u00f3\u0142nocne' >Mariany P\u00f3\u0142nocne<\/option><option value='Maroko' >Maroco<\/option><option value='Martynika' >Martynika<\/option><option value='Mauretania' >Mauretania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Meksyk' >Meksyk<\/option><option value='Mikronezja' >Mikronezja<\/option><option value='Mjanma' >Mjanma<\/option><option value='Monako' >Monako<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambik' >Mozambik<\/option><option value='Mo\u0142dawia' >Mo\u0142dawia<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Niemcy' >Niemcy<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Nikaragua' >Nikaragua<\/option><option value='Niue' >Niue<\/option><option value='Norwegia' >Norwegia<\/option><option value='Nowa Kaledonia' >Nowa Kaledonia<\/option><option value='Nowa Zelandia' >Nowa Zelandia<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestyna' >Palestyna<\/option><option value='Panama' >Panama<\/option><option value='Papua Nowa Gwinea' >Papua Nowa Gwinea<\/option><option value='Paragwaj' >Paragwaj<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinezja Francuska' >Polinezja Francuska<\/option><option value='Polska' >Polska<\/option><option value='Portoryko' >Portoryko<\/option><option value='Portugalia' >Portugalia<\/option><option value='Po\u0142udniowa Afryka' >Po\u0142udniowa Afryka<\/option><option value='P\u00f3\u0142nocna Macedonia' >Macedonia P\u00f3\u0142nocna<\/option><option value='Republika Afryki \u015arodkowej' >Republika Afryki \u015arodkowej<\/option><option value='Republika Zielonego Przyl\u0105dka' >Republika Zielonego Przyl\u0105dka<\/option><option value='Reunion' >Reunion<\/option><option value='Rumunia' >Rumunia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Sahara Zachodnia' >Sahara Zachodnia<\/option><option value='Saint Kitts i Nevis' >Saint Kitts i Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Pierre i Miquelon' >Saint-Pierre i Miquelon<\/option><option value='Saint Vincent i Grenadyny' >Saint Vincent i Grenadyny<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Martin' >Saint-Martin<\/option><option value='Salwador' >Salwador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Ameryka\u0144ska' >Samoa Ameryka\u0144ska<\/option><option value='San Marino' >San Marino<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seszele' >Sesceles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='South Georgia and the South Sandwich Islands' >Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowy<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Stany Zjednoczone' >Stany Zjednoczone<\/option><option value='Stolica Apostolska' >Stolica Apostolska<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan Po\u0142udniowy' >Sudan Po\u0142udniowy<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard i Jan Mayen' >Svalbard i Jan Mayen<\/option><option value='Syryjska Republika Arabska' >Syryjska Republika Arabska<\/option><option value='Szwajcaria' >Szwajcaria<\/option><option value='Szwecja' >Szwecja<\/option><option value='S\u0142owacja' >S\u0142owacja<\/option><option value='S\u0142owenia' >S\u0142owenia<\/option><option value='Tad\u017cykistan' >Tad\u017cykistan<\/option><option value='Tajlandia' >Tajlandia<\/option><option value='Tajwan' >Tajwan<\/option><option value='Tanzania, Zjednoczona Republika' >Tanzania, Zjednoczona Republika<\/option><option value='Timor-Leste' >Timor Wschodni<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trynidad i Tobago' >Trynidad i Tobago<\/option><option value='Tunezja' >Tunezja<\/option><option value='Turcja' >Turcja<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >Mniejsze Wyspy Zewn\u0119trzne Stan\u00f3w Zjednoczonych<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraina' >Ukraina<\/option><option value='Urugwaj' >Urugwaj<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Wallis i Futuna' >Wallis i Futuna<\/option><option value='Wenezuela' >Wenezuela<\/option><option value='Wietnam' >Wietnam<\/option><option value='Wybrze\u017ce Ko\u015bci S\u0142oniowej' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='Wyspa Bo\u017cego Narodzenia' >Wyspa Bo\u017cego Narodzenia<\/option><option value='Wyspa Man' >Wyspa Man<\/option><option value='Wyspa Norfolk' >Wyspa Norfolk<\/option><option value='Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='Wyspy Alandzkie' >Wyspy Alandzkie<\/option><option value='Wyspy Bouvet' >Wyspy Bouveta<\/option><option value='Wyspy Cooka' >Wyspy Cooka<\/option><option value='Wyspy Dziewicze, U.S.A.' >Wyspy Dziewicze, USA.<\/option><option value='Wyspy Dziewicze, Wielka Brytania' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='Wyspy Kokosowe' >Wyspy Kokosowe<\/option><option value='Wyspy Marshalla' >Wyspy Marshalla<\/option><option value='Wyspy Owcze' >Wyspy Owcze<\/option><option value='Wyspy Salomona' >Wyspy Salomona<\/option><option value='Wyspy Turks i Caicos' >Wyspy Turks i Caicos<\/option><option value='Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='W\u0119gry' >W\u0119gry<\/option><option value='W\u0142ochy' >W\u0142ochy<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zjednoczone Emiraty Arabskie' >Zjednoczone Emiraty Arabskie<\/option><option value='Zjednoczone Kr\u00f3lestwo' >Zjednoczone Kr\u00f3lestwo<\/option><option value='\u0141otwa' >\u0141otwa<\/option><\/select>\n                                        <label for='input_22_44_6' id='input_22_44_6_label' class='gform-field-label gform-field-label--type-sub'>Kraj<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_45\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_45'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_45' id='input_22_45' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_46\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_46'>e-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_46' id='input_22_46' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_22_47\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_47'>Charakter i zakres obra\u017ce\u0144<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_22_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Zapi\u0119te pasy bezpiecze\u0144stwa?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_49'>\n\t\t\t<div class='gchoice gchoice_22_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Ja'  id='choice_22_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_49_0' id='label_22_49_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Nein'  id='choice_22_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_49_1' id='label_22_49_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_50\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Hospitalizacja?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_50'>\n\t\t\t<div class='gchoice gchoice_22_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Ja'  id='choice_22_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_50_0' id='label_22_50_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Nein'  id='choice_22_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_50_1' id='label_22_50_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_51\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_51'>Kt\u00f3ry szpital?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_22_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy wypadek mia\u0142 miejsce w drodze do lub z pracy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_63'>\n\t\t\t<div class='gchoice gchoice_22_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Ja'  id='choice_22_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_63_0' id='label_22_63_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Nein'  id='choice_22_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_63_1' id='label_22_63_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy poszkodowany jest obj\u0119ty ustawowym ubezpieczeniem emerytalnym?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_64'>\n\t\t\t<div class='gchoice gchoice_22_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Ja'  id='choice_22_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_64_0' id='label_22_64_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Nein'  id='choice_22_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_64_1' id='label_22_64_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy inne osoby zosta\u0142y ranne?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_75'>\n\t\t\t<div class='gchoice gchoice_22_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Ja'  id='choice_22_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_75_0' id='label_22_75_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Nein'  id='choice_22_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_75_1' id='label_22_75_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_52\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_52'>Pozdrowienie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_22_52' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Pan<\/option><option value='Frau' >Pani<\/option><option value='Keine Angabe' >Nie okre\u015blono<\/option><\/select><\/div><\/div><fieldset id=\"field_22_53\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nazwa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_53'>\n                            \n                            <span id='input_22_53_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.3' id='input_22_53_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_53_3' class='gform-field-label gform-field-label--type-sub'>Imi\u0119<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_53_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.6' id='input_22_53_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_53_6' class='gform-field-label gform-field-label--type-sub'>Nazwisko<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_54\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_54_1_container' >\n                                        <input type='text' name='input_54.1' id='input_22_54_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_54_1' id='input_22_54_1_label' class='gform-field-label gform-field-label--type-sub'>Ulica<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_54_3_container' >\n                                    <input type='text' name='input_54.3' id='input_22_54_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_54_3' id='input_22_54_3_label' class='gform-field-label gform-field-label--type-sub'>Miasto<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_54.4' id='input_22_54_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_54_5_container' >\n                                    <input type='text' name='input_54.5' id='input_22_54_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_54_5' id='input_22_54_5_label' class='gform-field-label gform-field-label--type-sub'>Kod pocztowy<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_54_6_container' >\n                                        <select name='input_54.6' id='input_22_54_6'   aria-required='true'    ><option value='' ><\/option><option value='Afganistan' >Afganistan<\/option><option value='Albania' >Albania<\/option><option value='Algieria' >Algieria<\/option><option value='Andora' >Andora<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarktyda' >Grobla antarktyczna<\/option><option value='Antigua i Barbuda' >Antigua i Barbuda<\/option><option value='Arabia Saudyjska' >Arabia Saudyjska<\/option><option value='Argentyna' >Argentyna<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbejd\u017can' >Azerbejd\u017can<\/option><option value='Bahamy' >Bahamy<\/option><option value='Bahrajn' >Bahrajn<\/option><option value='Bangladesz' >Bangladesz<\/option><option value='Barbados' >Barbados<\/option><option value='Belgia' >Belgia<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermudy' >Bermudy<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bia\u0142oru\u015b' >Bia\u0142oru\u015b<\/option><option value='Boliwia' >Boliwia<\/option><option value='Bonaire, St Eustatius i Saba' >Bonaire, St Eustatius i Saba<\/option><option value='Botswana' >Botswana<\/option><option value='Bo\u015bnia i Hercegowina' >Bo\u015bnia i Hercegowina<\/option><option value='Brazylia' >Brazylia<\/option><option value='Brunei Darussalam' >Pa\u0144stwo Brunei Darussalam<\/option><option value='Brytyjskie Terytorium Oceanu Indyjskiego' >Brytyjskie Terytorium Oceanu Indyjskiego<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Bu\u0142garia' >Bu\u0142garia<\/option><option value='Chile' >Chile<\/option><option value='Chiny' >Chiny<\/option><option value='Chorwacja' >Chorwacja<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cypr' >Cypr<\/option><option value='Czad' >Czad<\/option><option value='Czarnog\u00f3ra' >Czarnog\u00f3ra<\/option><option value='Czechy' >Czechy<\/option><option value='Dania' >Dania<\/option><option value='Demokratyczna Republika Kongo' >Demokratyczna Republika Konga<\/option><option value='Dominikana' >Dominicana<\/option><option value='Dominikana, Republika' >Dominikana, Republika<\/option><option value='D\u017cibuti' >D\u017cibuti<\/option><option value='Egipt' >Egipt<\/option><option value='Ekwador' >Ekwador<\/option><option value='Erytrea' >Erytrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Suazi)' >Eswatini (Suazi)<\/option><option value='Etiopia' >Etiopia<\/option><option value='Falklandy' >Falklandy<\/option><option value='Federacja Rosyjska' >Federacja Rosyjska<\/option><option value='Fid\u017ci' >Fid\u017ci<\/option><option value='Filipiny' >Filipiny<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francja' >Francja<\/option><option value='Francuskie Terytoria Po\u0142udniowe' >Francuskie Terytoria Po\u0142udniowe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grecja' >Grecja<\/option><option value='Grenada' >Grenada<\/option><option value='Grenlandia' >Grenlandia<\/option><option value='Gruzja' >Gruzja<\/option><option value='Guam' >Guam<\/option><option value='Guernsey' >Guernsey<\/option><option value='Gujana' >Gujana<\/option><option value='Gujana Francuska' >Gujana Francuska<\/option><option value='Gwadelupa' >Gwadelupa<\/option><option value='Gwatemala' >Gwatemala<\/option><option value='Gwinea' >Gwinea<\/option><option value='Gwinea Bissau' >Gwinea Bissau<\/option><option value='Gwinea R\u00f3wnikowa' >Gwinea R\u00f3wnikowa<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Wyspa Heard i Wyspy McDonalda<\/option><option value='Hiszpania' >Hiszpania<\/option><option value='Holandia' >Holandia<\/option><option value='Honduras' >Honduras<\/option><option value='Hongkong' >Hongkong<\/option><option value='Indie' >Indie<\/option><option value='Indonezja' >Indonezja<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlandia' >Irlandia<\/option><option value='Islandia' >Islandia<\/option><option value='Izrael' >Izrael<\/option><option value='Jamajka' >Jamajka<\/option><option value='Japonia' >Japonia<\/option><option value='Jemen' >Jemen<\/option><option value='Jersey' >Jersey<\/option><option value='Jordania' >Jordania<\/option><option value='Kajmany' >Kajmany<\/option><option value='Kambod\u017ca' >Kambod\u017ca<\/option><option value='Kamerun' >Kamerun<\/option><option value='Kanada' >Kanada<\/option><option value='Katar' >Katar<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kirgistan' >Kirgistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kolumbia' >Kolumbia<\/option><option value='Komory' >Comory<\/option><option value='Kongo' >Kongo<\/option><option value='Korea Po\u0142udniowa' >Korea Po\u0142udniowa<\/option><option value='Korea\u0144ska Republika Ludowo-Demokratyczna' >Korea\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Kostaryka' >Kostaryka<\/option><option value='Kuba' >Kuba<\/option><option value='Kuwejt' >Kuwejt<\/option><option value='Laota\u0144ska Republika Ludowo-Demokratyczna' >Laota\u0144ska Republika Ludowo-Demokratyczna<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libia' >Libia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litwa' >Litwa<\/option><option value='Luksemburg' >Luksemburg<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Majotta' >Majotta<\/option><option value='Makau' >Makau<\/option><option value='Malawi' >Malawi<\/option><option value='Malediwy' >Maledivy<\/option><option value='Malezja' >Malezja<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Mariany P\u00f3\u0142nocne' >Mariany P\u00f3\u0142nocne<\/option><option value='Maroko' >Maroco<\/option><option value='Martynika' >Martynika<\/option><option value='Mauretania' >Mauretania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Meksyk' >Meksyk<\/option><option value='Mikronezja' >Mikronezja<\/option><option value='Mjanma' >Mjanma<\/option><option value='Monako' >Monako<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambik' >Mozambik<\/option><option value='Mo\u0142dawia' >Mo\u0142dawia<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Niemcy' >Niemcy<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Nikaragua' >Nikaragua<\/option><option value='Niue' >Niue<\/option><option value='Norwegia' >Norwegia<\/option><option value='Nowa Kaledonia' >Nowa Kaledonia<\/option><option value='Nowa Zelandia' >Nowa Zelandia<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestyna' >Palestyna<\/option><option value='Panama' >Panama<\/option><option value='Papua Nowa Gwinea' >Papua Nowa Gwinea<\/option><option value='Paragwaj' >Paragwaj<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinezja Francuska' >Polinezja Francuska<\/option><option value='Polska' >Polska<\/option><option value='Portoryko' >Portoryko<\/option><option value='Portugalia' >Portugalia<\/option><option value='Po\u0142udniowa Afryka' >Po\u0142udniowa Afryka<\/option><option value='P\u00f3\u0142nocna Macedonia' >Macedonia P\u00f3\u0142nocna<\/option><option value='Republika Afryki \u015arodkowej' >Republika Afryki \u015arodkowej<\/option><option value='Republika Zielonego Przyl\u0105dka' >Republika Zielonego Przyl\u0105dka<\/option><option value='Reunion' >Reunion<\/option><option value='Rumunia' >Rumunia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Sahara Zachodnia' >Sahara Zachodnia<\/option><option value='Saint Kitts i Nevis' >Saint Kitts i Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Pierre i Miquelon' >Saint-Pierre i Miquelon<\/option><option value='Saint Vincent i Grenadyny' >Saint Vincent i Grenadyny<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Martin' >Saint-Martin<\/option><option value='Salwador' >Salwador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Ameryka\u0144ska' >Samoa Ameryka\u0144ska<\/option><option value='San Marino' >San Marino<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seszele' >Sesceles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Somalia' >Somalia<\/option><option value='South Georgia and the South Sandwich Islands' >Georgia Po\u0142udniowa i Wyspy Sandwich Po\u0142udniowy<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Stany Zjednoczone' >Stany Zjednoczone<\/option><option value='Stolica Apostolska' >Stolica Apostolska<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan Po\u0142udniowy' >Sudan Po\u0142udniowy<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard i Jan Mayen' >Svalbard i Jan Mayen<\/option><option value='Syryjska Republika Arabska' >Syryjska Republika Arabska<\/option><option value='Szwajcaria' >Szwajcaria<\/option><option value='Szwecja' >Szwecja<\/option><option value='S\u0142owacja' >S\u0142owacja<\/option><option value='S\u0142owenia' >S\u0142owenia<\/option><option value='Tad\u017cykistan' >Tad\u017cykistan<\/option><option value='Tajlandia' >Tajlandia<\/option><option value='Tajwan' >Tajwan<\/option><option value='Tanzania, Zjednoczona Republika' >Tanzania, Zjednoczona Republika<\/option><option value='Timor-Leste' >Timor Wschodni<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trynidad i Tobago' >Trynidad i Tobago<\/option><option value='Tunezja' >Tunezja<\/option><option value='Turcja' >Turcja<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >Mniejsze Wyspy Zewn\u0119trzne Stan\u00f3w Zjednoczonych<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraina' >Ukraina<\/option><option value='Urugwaj' >Urugwaj<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Wallis i Futuna' >Wallis i Futuna<\/option><option value='Wenezuela' >Wenezuela<\/option><option value='Wietnam' >Wietnam<\/option><option value='Wybrze\u017ce Ko\u015bci S\u0142oniowej' >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value='Wyspa Bo\u017cego Narodzenia' >Wyspa Bo\u017cego Narodzenia<\/option><option value='Wyspa Man' >Wyspa Man<\/option><option value='Wyspa Norfolk' >Wyspa Norfolk<\/option><option value='Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha' >Wyspa \u015awi\u0119tej Heleny, Wyspa Wniebowst\u0105pienia i Tristan da Cunha<\/option><option value='Wyspy Alandzkie' >Wyspy Alandzkie<\/option><option value='Wyspy Bouvet' >Wyspy Bouveta<\/option><option value='Wyspy Cooka' >Wyspy Cooka<\/option><option value='Wyspy Dziewicze, U.S.A.' >Wyspy Dziewicze, USA.<\/option><option value='Wyspy Dziewicze, Wielka Brytania' >Wyspy Dziewicze, Wielka Brytania<\/option><option value='Wyspy Kokosowe' >Wyspy Kokosowe<\/option><option value='Wyspy Marshalla' >Wyspy Marshalla<\/option><option value='Wyspy Owcze' >Wyspy Owcze<\/option><option value='Wyspy Salomona' >Wyspy Salomona<\/option><option value='Wyspy Turks i Caicos' >Wyspy Turks i Caicos<\/option><option value='Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca' >Wyspy \u015awi\u0119tego Tomasza i Ksi\u0105\u017c\u0119ca<\/option><option value='W\u0119gry' >W\u0119gry<\/option><option value='W\u0142ochy' >W\u0142ochy<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zjednoczone Emiraty Arabskie' >Zjednoczone Emiraty Arabskie<\/option><option value='Zjednoczone Kr\u00f3lestwo' >Zjednoczone Kr\u00f3lestwo<\/option><option value='\u0141otwa' >\u0141otwa<\/option><\/select>\n                                        <label for='input_22_54_6' id='input_22_54_6_label' class='gform-field-label gform-field-label--type-sub'>Kraj<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_55\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_55'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_55' id='input_22_55' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_56\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_56'>e-mail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_56' id='input_22_56' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_22_57\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_57'>Charakter i zakres obra\u017ce\u0144<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_22_57' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Zapi\u0119te pasy bezpiecze\u0144stwa?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_58'>\n\t\t\t<div class='gchoice gchoice_22_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Ja'  id='choice_22_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_58_0' id='label_22_58_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Nein'  id='choice_22_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_58_1' id='label_22_58_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Hospitalizacja?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_59'>\n\t\t\t<div class='gchoice gchoice_22_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Ja'  id='choice_22_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_59_0' id='label_22_59_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Nein'  id='choice_22_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_59_1' id='label_22_59_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_60\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_60'>Kt\u00f3ry szpital?<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_22_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy wypadek mia\u0142 miejsce w drodze do lub z pracy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_65'>\n\t\t\t<div class='gchoice gchoice_22_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Ja'  id='choice_22_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_65_0' id='label_22_65_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Nein'  id='choice_22_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_65_1' id='label_22_65_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Czy poszkodowany jest obj\u0119ty ustawowym ubezpieczeniem emerytalnym?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_66'>\n\t\t\t<div class='gchoice gchoice_22_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Ja'  id='choice_22_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_66_0' id='label_22_66_0' class='gform-field-label gform-field-label--type-inline'>Tak<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Nein'  id='choice_22_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_66_1' id='label_22_66_1' class='gform-field-label gform-field-label--type-inline'>Nie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_78\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Zgoda<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_78.1' id='input_22_78_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_22_78_1' >Zgadzam si\u0119 z polityk\u0105 prywatno\u015bci.<\/label><input type='hidden' name='input_78.2' value='Ich stimme der Datenschutzerkl\u00e4rung zu.' class='gform_hidden' \/><input type='hidden' name='input_78.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_22_79\" class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_79'>CAPTCHA<\/label><div id='input_22_79' class='ginput_container ginput_recaptcha' data-sitekey=''  data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_22' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='WY\u015aLIJ'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_22' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_22' id='gform_theme_22' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_22' id='gform_style_settings_22' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_22' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='22' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_22' 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class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-31f7102 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"31f7102\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-95794d5\" data-id=\"95794d5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-71f072d elementor-widget elementor-widget-menu-anchor\" data-id=\"71f072d\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"PDFSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-90c9bc1 elementor-widget elementor-widget-heading\" data-id=\"90c9bc1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Kwestionariusz dla wnioskodawc\u00f3w do pobrania<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d0341b3 elementor-widget elementor-widget-text-editor\" data-id=\"d0341b3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Je\u015bli zdecydujesz si\u0119 na opcj\u0119 pisemn\u0105, prze\u015blij nam j\u0105 - najlepiej poczt\u0105 elektroniczn\u0105 - na adres\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-333a1f6 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"333a1f6\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-home-lg-alt\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c40eef8 elementor-widget elementor-widget-button\" data-id=\"c40eef8\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/formular-fuer-anspruchsteller_schadensabwicklung-kvg.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-pdf\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">DO KWESTIONARIUSZA W FORMACIE PDF<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-4c41ccb e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"4c41ccb\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-09ad7e8 elementor-widget elementor-widget-spacer\" data-id=\"09ad7e8\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a1d88b2 elementor-widget elementor-widget-menu-anchor\" data-id=\"a1d88b2\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"KontaktSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-56e5a1f elementor-widget elementor-widget-heading\" data-id=\"56e5a1f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Skontaktuj si\u0119 z nami!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7abc783 elementor-widget elementor-widget-text-editor\" data-id=\"7abc783\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Masz pytania lub chcesz nam o czym\u015b powiedzie\u0107? Jeste\u015bmy dost\u0119pni w czwartki od 8:00 do 16:00 i w pi\u0105tki od 8:00 do 12:00.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-28a485b elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"28a485b\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:051414870854\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">05141 48708-54<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3d99896 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"3d99896\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3711808 elementor-widget elementor-widget-spacer\" data-id=\"3711808\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c25912d elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"c25912d\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_18' ><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/cuxhaven\/pl\/wp-json\/wp\/v2\/pages\/1731' data-formid='18' novalidate data-trp-original-action=\"\/cuxhaven\/pl\/wp-json\/wp\/v2\/pages\/1731\">\n                        <div class='gform-body gform_body'><div id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_18_1\" class=\"gfield gfield--type-survey gfield--input-type-rating field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field\"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >Jak ci si\u0119 podoba nasza strona?<\/label><div class='ginput_container gsurvey-rating-wrapper'><div class='gsurvey-rating' id='input_18_1'><input name='input_1' type='radio' value='grating172b515f7'  id='choice_18_1_0'    \/><label for='choice_18_1_0' title='Znakomity'><span>Znakomity<\/span><\/label><input name='input_1' type='radio' value='grating15b90bab7'  id='choice_18_1_1'    \/><label for='choice_18_1_1' title='Przewa\u017cnie dobry'><span>Przewa\u017cnie dobry<\/span><\/label><input name='input_1' type='radio' value='grating196111746'  id='choice_18_1_2'    \/><label 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false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ceb2b2f elementor-widget elementor-widget-spacer\" data-id=\"ceb2b2f\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>POST\u0118POWANIE REKLAMACYJNE W PRZYPADKU WYPADK\u00d3W Je\u015bli Tw\u00f3j bilet MobilityTicket zosta\u0142 zgubiony lub uszkodzony, mo\u017cesz \u0142atwo ubiega\u0107 si\u0119 o bilet zast\u0119pczy tutaj. Je\u015bli mia\u0142e\u015b wypadek z KVG, skontaktuj si\u0119 z nami przed podj\u0119ciem dalszych krok\u00f3w. Kwestionariusz dla wnioskodawc\u00f3w mo\u017cna wype\u0142ni\u0107 online lub pobra\u0107 w formacie PDF. Prosimy o do\u0142\u0105czenie do listu wszystkich istotnych informacji i dokument\u00f3w dotycz\u0105cych wypadku (np. zdj\u0119\u0107, zezna\u0144 \u015bwiadk\u00f3w, raportu policyjnego), aby\u015bmy mogli szybko rozpatrzy\u0107 wniosek. Kwestionariusz dla wnioskodawc\u00f3w \u201e*\u201c oznacza pola wymagane Dane osobowe Salutation*MrMrsNo details Nazwisko* Imi\u0119 Surname Telefon*Email* Adres* Address Miasto Postcode AfganistanAlbaniaAlgeriaAmerican-SamoaAmeryka\u0144skie Wyspy DziewiczeAndoraAngolaAnguillaAntarktydaAntigua i BarbudaArgentynaArmeniaArubaAzerbejd\u017canAustraliaBahamyBahrajnBangladeszBarbadosBelgiaBelizeBeninBermudyBhutanBoliwiaBo\u015bnia i HercegowinaBotswanaWyspa BouvetaBrazyliaBrytyjskie Wyspy DziewiczeBrytyjskie Terytorium Oceanu IndyjskiegoBrunei Ocean IndyjskiBrunei DarussalamBu\u0142gariaBurkina FasoBurundiWyspy Kajma\u0144skieChileChinyWyspy CookaCosta RicaCura\u00e7aoWybrze\u017ce Ko\u015bci S\u0142oniowejLaos Demokratyczna Republika LudowaDaniaD\u017cibutiDominikaRepublika Dominika\u0144skaEkwadorEl SalvadorErytreaEstoniaEswatiniFalklandyFijiFinlandiaFrancjaGujana FrancuskaFrancjaGujana FrancuskaPolinezja FrancuskaTerytoria Po\u0142udniowe i AntarktyczneFutuna (Wallis i Futuna)Wyspy OwczeGabonGambiaGeorgiaGhanaGibraltarGrenadaGrecjaWielka BrytaniaGrenlandiaGwadelupaGuamGwatemalaGuernseyGwineaGwinea-BissauGujanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndieIndonezjaIrakIranIrelandiaIsle of ManIsraelItalyJamaicaJapanJerseyJordanKambod\u017caKamerunKanadaCape VerdeKaraibyNiderlandyKazachstanKeniaKirgistanKiribatiWyspy KokosoweKongoKongo, Demokratyczna Republika Korei Demokratyczna Republika LudowaChorwacjaKubaKuwejtLesotho\u0141otwaLebanLibiaLiechtensteinLitwaLuksemburgMakauMadagaskarMalawiMalezjaMalediwyMaliMaltaMarokoMarshall-WyspyMartynikaMauretaniaMauritiusMajottaMeksykMikronezjaMo\u0142dawiaMonakoMongoliaMontenegroMontserratMozambikMyanmarNamibiaNauruNepalNowa KaledoniaNowa ZelandiaNikaraguaNiderlandyNigerNigeriaNiueMacedonia P\u00f3\u0142nocnaNorfolkNorwayNorthern Mariana IslandsOmanEast TimorPakistanPalauPalestine, PalauPalestynaPanamaPapua Nowa GwineaParagwajPeruFilipinyWyspy PitcairnPolskaPortugaliaPortorykoRwandaRumuniaFederacja RosyjskaR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre i MiquelonWyspy SalomonaZambiaSamoaSan MarinoArabia SaudyjskaSzwecjaSenegalSerbiaSeszeleSierra LeoneZimbabweSingapurSint MaartenS\u0142oweniaS\u0142owacjaSomaliaHiszpaniaSri LankaSt. Helena, Wniebowst\u0105pienie i Tristan da CunhaSt. Kitts i NevisSt. LuciaSt. MartinSt. Vincent i GrenadynySudanSurinamSvalbard i Jan MayenSyria, Republika ArabskaS\u00e3o Tom\u00e9 i Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, TajlandiaTogoTokelauTongaTrynidad i TobagoCzechyTunezjaTurkmenistanTurks i CaicosTuvaluTurcjaMa\u0142e Wyspy Zewn\u0119trzneUSAUgandaUkrainaW\u0119gryUrugwajUsbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany ZjednoczoneAmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCyprEgiptGwinea R\u00f3wnikowaTiopiaWyspy AlandzkieAustria Kraj Szczeg\u00f3\u0142y wypadku Miejsce* Data* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Czas* Godziny : Minuty Ulica\/skrzy\u017cowanie*Linia\/Numer przejazdu*PrzystanekTablica rejestracyjna autobusuNazwa kierowcy Oznakowanie wypadku*Plik Przeci\u0105gnij pliki tutaj lub Wybierz pliki Maks. rozmiar pliku 32 MB. Rozmiar pliku: 32 MB. \u015awiadkowie Czy s\u0105 jacy\u015b \u015bwiadkowie* Tak Nie Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy Telefon Czy s\u0105 jacy\u015b inni \u015bwiadkowie* Tak Nie Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy Telefon* Policja Numer incydentu Adres Miasto Kod pocztowy PlikMax. Rozmiar pliku: 32 MB. Uszkodzenie mienia Czy dosz\u0142o do uszkodzenia mienia? Tak Nie Co zosta\u0142o uszkodzone? W\u0142a\u015bciciel (ewentualnie leasingodawca)* Imi\u0119 Nazwisko Uprawniony do odliczenia podatku naliczonego? Tak Nie Uszkodzenie pojazd\u00f3w silnikowych - samochod\u00f3w osobowych, ci\u0119\u017carowych itp. (je\u015bli dotyczy) Czy dosz\u0142o do uszkodzenia pojazdu silnikowego? Tak Nie Typ*Samoch\u00f3d osobowy (samoch\u00f3d osobowy)Pojazd u\u017cytkowy (ci\u0119\u017car\u00f3wka)Pojazd dwuko\u0142owy (skuter, motocykl)Maszyny rolnicze\/budowlaneMotorower\/przyczepa kempingowaProducent*TypNumer rejestracyjny*Ubezpieczenie* Obra\u017cenia cia\u0142a Czy dosz\u0142o do obra\u017ce\u0144 cia\u0142a?* Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy AfganistanAlbaniaAlgieriaAmeryka\u0144skie Wyspy Dziewicze SamoaAmeryka\u0144skie Wyspy DziewiczeSamoaAmeryka\u0144skie Wyspy DziewiczeAndoraAngolaAnguillaAntarktydaAntigua i BarbudaArgentynaArmeniaArubaAzerbejd\u017canAustraliaBahamyBahrajnBangladeszBarbadosBelgiaBelizeBeninBermudyBhutanBoliwiaBo\u015bnia i HercegowinaBotswanaWyspa BouvetaBrazyliaBrytyjskie Wyspy DziewiczeBrytyjskie Terytorium Oceanu IndyjskiegoBrunei Darussi Ocean IndyjskiBrunei DarussalamBu\u0142gariaBurkina FasoBurundiWyspy Kajma\u0144skieChileChinyWyspy CookaCosta RicaCura\u00e7aoWybrze\u017ce Ko\u015bci S\u0142oniowejLaos Demokratyczna Republika LudowaDaniaD\u017cibutiDominikaRepublika Dominika\u0144skaEkwadorEl SalvadorErytreaEstoniaEswatiniFalklandyFijiFinlandiaFrancjaGujana FrancuskaFrancjaGujana FrancuskaPolinezja FrancuskaTerytoria Po\u0142udniowe i AntarktyczneFutuna (Wallis i Futuna)Wyspy OwczeGabonGambiaGeorgiaGhanaGibraltarGrenadaGrecjaWielka BrytaniaGrenlandiaGwadelupaGuamGwatemalaGuernseyGwineaGwinea-BissauGujanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndieIndonezjaIrakIranIrlandiaIsle of ManIsraelItalyJamaicaJapanJerseyJordanKambod\u017caKamerunKanadaCape VerdeKaraibyNiderlandyKazachstanKeniaKirgistanKiribatiWyspy KokosoweKongoKongo, Demokratyczna Republika Korei Demokratyczna Republika LudowaChorwacjaKubaKuwejtLesotho\u0141otwaLebanLibiaLiechtensteinLitwaLuksemburgMakauMadagaskarMalawiMalezjaMaldiwyMaliMaltaMarokoMarshall-WyspyMartynikaMauretaniaMauritiusMajottaMeksykMikronezjaMo\u0142dawiaMonakoMongoliaMontenegroMontserratMozambikMyanmarNamibiaNauruNepalNowa KaledoniaNowa ZelandiaNikaraguaNiderlandyNigerNigeriaNiueMacedonia P\u00f3\u0142nocnaNorfolkNorwegiaMariany P\u00f3\u0142nocneOmanTimor WschodniPakistanPalauPalestyna, PalauPalestynaPanamaPapua Nowa GwineaParagwajPeruFilipinyWyspy PitcairnPolskaPortugaliaPortorykoRwandaRumuniaFederacja RosyjskaR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre i MiquelonWyspy SalomonaZambiaSamoaSan MarinoArabia SaudyjskaSzwecjaSenegalSerbiaSeszeleSierra LeoneZimbabweSingapurSint MaartenS\u0142oweniaS\u0142owacjaSomaliaHiszpaniaSri LankaSt. Helena, Wniebowst\u0105pienie i Tristan da CunhaSt. Kitts i NevisSt. LuciaSt. MartinSt. Vincent i GrenadynySudanSurinamSvalbard i Jan MayenSyria, Republika ArabskaS\u00e3o Tom\u00e9 i Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, TajlandiaTogoTokelauTongaTrynidad i TobagoCzechyTunezjaTurkmenistanTurks i CaicosTuvaluTurcjaMa\u0142e Wyspy Zewn\u0119trzne USAUgandaUkrainaW\u0119gryUrugwajUsbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany Zjednoczone AmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCyprEgiptGwinea R\u00f3wnikowaTiopiaWyspy AlandzkieAustria Kraj Telefon*Email Rodzaj i zakres obra\u017ce\u0144* Zapi\u0119te pasy bezpiecze\u0144stwa? Tak Nie Hospitalizacja* Tak Nie Kt\u00f3ry szpital? Czy wypadek mia\u0142 miejsce w drodze do lub z pracy? Tak Nie Czy osoba poszkodowana jest obj\u0119ta ustawowym ubezpieczeniem emerytalnym? Tak Nie Czy inne osoby zosta\u0142y poszkodowane?* Nazwisko* Imi\u0119 Nazwisko Adres* Adres Miasto Kod pocztowy AfganistanAlbaniaAlgieriaAmeryka\u0144skie SamoaAmeryka\u0144skie Wyspy Dziewicze SamoaAmeryka\u0144skie Wyspy DziewiczeSamoaAmeryka\u0144skie Wyspy DziewiczeAndoraAngolaAnguillaAntarktydaAntigua i BarbudaArgentynaArmeniaArubaAzerbejd\u017canAustraliaBahamyBahrajnBangladeszBarbadosBelgiaBelizeBeninBermudyBhutanBoliwiaBo\u015bnia i HercegowinaBotswanaWyspa BouvetaBrazyliaBrytyjskie Wyspy DziewiczeBrytyjskie Terytorium Oceanu IndyjskiegoBrunei Darussi Ocean IndyjskiBrunei DarussalamBu\u0142gariaBurkina FasoBurundiWyspy Kajma\u0144skieChileChinyWyspy CookaCosta RicaCura\u00e7aoWybrze\u017ce Ko\u015bci S\u0142oniowejLaos Demokratyczna Republika LudowaDaniaD\u017cibutiDominikaRepublika Dominika\u0144skaEkwadorEl SalvadorErytreaEstoniaEswatiniFalklandyFijiFinlandiaFrancjaGujana FrancuskaFrancjaGujana FrancuskaPolinezja FrancuskaTerytoria Po\u0142udniowe i AntarktyczneFutuna (Wallis i Futuna)Wyspy OwczeGabonGambiaGeorgiaGhanaGibraltarGrenadaGrecjaWielka BrytaniaGrenlandiaGwadelupaGuamGwatemalaGuernseyGwineaGwinea-BissauGujanaHaitiHeard and McDonaldIslandsHoly SeeHondurasHong KongIndieIndonezjaIrakIranIrlandiaIsle of ManIsraelItalyJamaicaJapanJerseyJordanKambod\u017caKamerunKanadaCape VerdeKaraibyNiderlandyKazachstanKeniaKirgistanKiribatiWyspy KokosoweKongoKongo, Demokratyczna Republika Korei Demokratyczna Republika LudowaChorwacjaKubaKuwejtLesotho\u0141otwaLebanLibiaLiechtensteinLitwaLuksemburgMakauMadagaskarMalawiMalezjaMaldiwyMaliMaltaMarokoMarshall-WyspyMartynikaMauretaniaMauritiusMajottaMeksykMikronezjaMo\u0142dawiaMonakoMongoliaMontenegroMontserratMozambikMyanmarNamibiaNauruNepalNowa KaledoniaNowa ZelandiaNikaraguaNiderlandyNigerNigeriaNiueMacedonia P\u00f3\u0142nocnaNorfolkNorwegiaMariany P\u00f3\u0142nocneOmanTimor WschodniPakistanPalauPalestyna, PalauPalestynaPanamaPapua Nowa GwineaParagwajPeruFilipinyWyspy PitcairnPolskaPortugaliaPortorykoRwandaRumuniaFederacja RosyjskaR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre i MiquelonWyspy SalomonaZambiaSamoaSan MarinoArabia SaudyjskaSzwecjaSenegalSerbiaSeszeleSierra LeoneZimbabweSingapurSint MaartenS\u0142oweniaS\u0142owacjaSomaliaHiszpaniaSri LankaSt. Helena, Wniebowst\u0105pienie i Tristan da CunhaSt. Kitts i NevisSt. LuciaSt. MartinSt. Vincent i GrenadynySudanSurinamSvalbard i Jan MayenSyria, Republika ArabskaS\u00e3o Tom\u00e9 i Pr\u00edncipeSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanTajikistanTaiwanTanzania, TajlandiaTogoTokelauTongaTrynidad i TobagoCzechyTunezjaTurkmenistanTurks i CaicosTuvaluTurcjaMa\u0142e Wyspy Zewn\u0119trzne USAUgandaUkrainaW\u0119gryUrugwajUsbekistanVanuatuWenezuelaZjednoczone Emiraty ArabskieStany Zjednoczone AmerykiWietnamWyspa Bo\u017cego NarodzeniaBia\u0142oru\u015bSahara ZachodniaRepublika \u015arodkowoafryka\u0144skaCyprEgiptGwinea R\u00f3wnikowaTiopiaWyspy AlandzkieAustria Kraj Telefon*Email Rodzaj i zakres obra\u017ce\u0144* Zapi\u0119te pasy bezpiecze\u0144stwa? Tak Nie Hospitalizacja* Tak Nie Kt\u00f3ry szpital? Czy wypadek mia\u0142 miejsce w drodze do lub z pracy? Tak Nie Czy osoba poszkodowana posiada ustawowe ubezpieczenie emerytalne? Tak Nie Zgoda* Zgadzam si\u0119 z polityk\u0105 prywatno\u015bci. Kwestionariusz CAPTCHA dla wnioskodawc\u00f3w do pobrania Je\u015bli zdecydujesz si\u0119 na opcj\u0119 pisemn\u0105, prze\u015blij j\u0105 do nas - najlepiej poczt\u0105 elektroniczn\u0105 - na adres versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle DO POBRANIA KWESTIONARIUSZ W FORMACIE PDF Tw\u00f3j kontakt z nami! Masz pytania lub chcesz nam co\u015b powiedzie\u0107? Jeste\u015bmy do Twojej dyspozycji w czwartki od 8 do 16 i w pi\u0105tki od 8 do 12. 05141 48708-54 versicherung@kvg-bus.de Jak podoba Ci si\u0119 nasza strona internetowa? ZnakomicieNajbardziej dobrzeNieznacznieNiezbyt dobrzeStrasznieNa kt\u00f3rej stronie jeste\u015b?(wymagane) Czy jest co\u015b jeszcze, co chcia\u0142by\u015b nam powiedzie\u0107?<\/p>","protected":false},"author":4,"featured_media":1567,"parent":16,"menu_order":30,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1731","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Schadenabwicklung - KVG Cuxhaven<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kvg-bus.de\/cuxhaven\/usluga\/zaspokajanie-roszczen\/\" \/>\n<meta property=\"og:locale\" content=\"pl_PL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schadenabwicklung - KVG Cuxhaven\" \/>\n<meta property=\"og:description\" content=\"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Wenn dein Mobilit\u00e4tsTicket verloren gegangen oder besch\u00e4digt ist, kannst du hier ganz einfach ein Ersatz-Ticket beantragen. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. Dateigr\u00f6\u00dfe: 32 MB. Zeugen Gibt es Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon Gibt es weitere Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon* Polizeiaufnahme DienststelleVorgangsnummer Anschrift Anschrift Stadt PLZ DateiMax. Dateigr\u00f6\u00dfe: 32 MB. Sachsch\u00e4den Liegt eine Sachbesch\u00e4digung vor?* Ja Nein Was wurde besch\u00e4digt?* Eigent\u00fcmer (evtl. Leasinggeber)* Vorname Nachname Vorsteuerabzugsberechtigt?* Ja Nein Besch\u00e4digung an Kraftfahrzeugen &#8211; PKW, LKW etc. (falls vorhanden) Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?* Ja Nein Art*PKW (Auto)Nutzfahrzeuge (LKW)Zweirad (Roller, Motorrad)Land-\/ BaumaschinenWohnmobil\/WohnwagenHersteller*TypAmtl. Kennzeichen*Versicherung* Personensch\u00e4den Liegen Personensch\u00e4den vor?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Einwilligung* Ich stimme der Datenschutzerkl\u00e4rung zu. CAPTCHA Fragebogen f\u00fcr Anspruchssteller als Download Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheide sende uns diesen &#8211; bevorzugt per E-Mail &#8211; an\u00a0 versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle ZUM FRAGEBOGEN ALS PDF Dein Kontakt zu uns! Du hast Fragen oder m\u00f6chtest uns etwas mitteilen? Wir sind donnerstags von 8 &#8211; 16 Uhr und freitags von 8 &#8211; 12 Uhr f\u00fcr dich erreichbar.\u00a0 05141 48708-54 versicherung@kvg-bus.de Wie gut gef\u00e4llt dir unsere Website?HerausragendVorwiegend gutNeutralNicht gutFurchtbarAuf welcher Seite befindest du dich?(erforderlich) M\u00f6chtest du uns sonst noch etwas sagen?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/kvg-bus.de\/cuxhaven\/usluga\/zaspokajanie-roszczen\/\" \/>\n<meta property=\"og:site_name\" content=\"KVG Cuxhaven\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-30T08:29:35+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Szacowany czas czytania\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minut\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/\",\"url\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/\",\"name\":\"Schadenabwicklung - KVG Cuxhaven\",\"isPartOf\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/kvg-bus.de\/cuxhaven\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"datePublished\":\"2025-10-09T12:25:28+00:00\",\"dateModified\":\"2025-10-30T08:29:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/#breadcrumb\"},\"inLanguage\":\"pl-PL\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pl-PL\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/#primaryimage\",\"url\":\"https:\/\/kvg-bus.de\/cuxhaven\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"contentUrl\":\"https:\/\/kvg-bus.de\/cuxhaven\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/schadenabwicklung\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"https:\/\/kvg-bus.de\/cuxhaven\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Service\",\"item\":\"https:\/\/kvg-bus.de\/cuxhaven\/service\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Schadenabwicklung\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#website\",\"url\":\"https:\/\/kvg-bus.de\/cuxhaven\/\",\"name\":\"KVG Cuxhaven\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/kvg-bus.de\/cuxhaven\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pl-PL\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#organization\",\"name\":\"KVG Cuxhaven\",\"url\":\"https:\/\/kvg-bus.de\/cuxhaven\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pl-PL\",\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/kvg-bus.de\/cuxhaven\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"contentUrl\":\"https:\/\/kvg-bus.de\/cuxhaven\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"caption\":\"KVG Cuxhaven\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/cuxhaven\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Rozliczanie roszcze\u0144 - KVG Cuxhaven","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/kvg-bus.de\/cuxhaven\/usluga\/zaspokajanie-roszczen\/","og_locale":"pl_PL","og_type":"article","og_title":"Schadenabwicklung - KVG Cuxhaven","og_description":"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Wenn dein Mobilit\u00e4tsTicket verloren gegangen oder besch\u00e4digt ist, kannst du hier ganz einfach ein Ersatz-Ticket beantragen. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. Dateigr\u00f6\u00dfe: 32 MB. Zeugen Gibt es Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon Gibt es weitere Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon* Polizeiaufnahme DienststelleVorgangsnummer Anschrift Anschrift Stadt PLZ DateiMax. Dateigr\u00f6\u00dfe: 32 MB. Sachsch\u00e4den Liegt eine Sachbesch\u00e4digung vor?* Ja Nein Was wurde besch\u00e4digt?* Eigent\u00fcmer (evtl. Leasinggeber)* Vorname Nachname Vorsteuerabzugsberechtigt?* Ja Nein Besch\u00e4digung an Kraftfahrzeugen &#8211; PKW, LKW etc. (falls vorhanden) Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?* Ja Nein Art*PKW (Auto)Nutzfahrzeuge (LKW)Zweirad (Roller, Motorrad)Land-\/ BaumaschinenWohnmobil\/WohnwagenHersteller*TypAmtl. Kennzeichen*Versicherung* Personensch\u00e4den Liegen Personensch\u00e4den vor?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. 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