English Translation

4202n Order of the Chief of the Polish Government and SD. No. 43/43 Wage withdrawals Period for which the date of payment of the attestation of the paying state Cash Pay-off payment of the payment Pay-out payment (2 signatures of the signatory is provided RM and seal of service of the cashier) In order for the paying state cashier: Each pay-off must be certified by the paying State cashier on the back of the wage certificate in the intended columns. The payee shall immediately receive the salary certificate after payment. The amount paid shall be invoiced by the paying cash with the State cash register indicated in advance, indicating the recipient, the period for which the remuneration is paid, and the amount paid, as well as the over-recognised registration mark (staff number). The deductions are settled by the state treasury responsible for the operation.