{"id":382,"date":"2025-06-28T11:30:29","date_gmt":"2025-06-28T09:30:29","guid":{"rendered":"https:\/\/new.fedorowska.pl\/?page_id=382"},"modified":"2026-07-08T14:35:55","modified_gmt":"2026-07-08T12:35:55","slug":"wniosek-o-mediacje","status":"publish","type":"page","link":"https:\/\/new.fedorowska.pl\/index.php\/wniosek-o-mediacje\/","title":{"rendered":"Wniosek o mediacj\u0119"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; theme_builder_area=&#8221;post_content&#8221; _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221;][et_pb_row _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; type=&#8221;4_4&#8243; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h2 class=\"title\">Wniosek o Przeprowadzenie Mediacji<\/h2>\n<div class=\"entry clearfix\">\n<div class=\"pf-content\">\n<p><span style=\"text-decoration: underline;\"><a title=\"Instrukcja Prawid\u0142owego Wype\u0142nienia Wniosku\" href=\"https:\/\/new.fedorowska.pl\/index.php\/instrukcja-prawidlowego-wypelnienia-wniosku\/\" target=\"_blank\" rel=\"noopener\"><strong>INSTRUKCJA PRAWID\u0141OWEGO WYPE\u0141NIENIA WNIOSKU<\/strong><\/a><\/span><\/p>\n<\/div>\n<\/div>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; type=&#8221;4_4&#8243; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><span><style id=\"wpforms-css-vars-1298\">\n\t\t\t\t#wpforms-1298 {\n\t\t\t\t--wpforms-field-border-radius: 0px;\n--wpforms-field-border-color: #cccccc;\n--wpforms-field-border-color-spare: #cccccc;\n--wpforms-field-text-color: #444444;\n--wpforms-label-color: #262626;\n--wpforms-label-sublabel-color: #7f7f7f;\n--wpforms-label-error-color: #ff0000;\n--wpforms-button-border-style: solid;\n--wpforms-button-border-radius: 0px;\n--wpforms-button-background-color: #dddddd;\n--wpforms-button-border-color: #cccccc;\n--wpforms-button-text-color: #666666;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-page-break-color: #dddddd;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1298\"><form id=\"wpforms-form-1298\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1298\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/382\" data-token=\"72c1aa94300732da9f88f039d27cb6b7\" data-token-time=\"1786089594\"><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1298-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_1\">Imi\u0119 i nazwisko <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1298-field_1-error\" required><\/div><div id=\"wpforms-1298-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_4\">Adres (ulica, nr domu) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-1298-field_4-error\" required><\/div>\t\t<div id=\"wpforms-1298-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1298-field_2\" >E-mail wniosek drugiego<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1298-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1298-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_6\">Kod pocztowy i miejscowo\u015b\u0107 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-1298-field_6-error\" required><\/div><div id=\"wpforms-1298-field_29-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_29\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1298-field_29\" class=\"wpforms-field-medium wpforms-field-required\" data-disable-suggestions=\"1\" name=\"wpforms[fields][29]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1298-field_29-error\" required><\/div><div id=\"wpforms-1298-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_21\">Telefon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1298-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" aria-errormessage=\"wpforms-1298-field_21-error\" required><\/div><div id=\"wpforms-1298-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_8\">Imi\u0119 i nazwisko drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-1298-field_8-error\" required><\/div><div id=\"wpforms-1298-field_10-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_10\">Adres drugiego uczestnika sporu (ulica, nr domu) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-1298-field_10-error\" required><\/div><div id=\"wpforms-1298-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_11\">Kod pocztowy i miejscowo\u015b\u0107 drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1298-field_11-error\" required><\/div><div id=\"wpforms-1298-field_12-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_12\">E-mail drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1298-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1298-field_12-error\" required><\/div><div id=\"wpforms-1298-field_22-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_22\">Telefon drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1298-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" step=\"any\" aria-errormessage=\"wpforms-1298-field_22-error\" required><\/div><div id=\"wpforms-1298-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_23\">W zwi\u0105zku z istniej\u0105cym sporem mi\u0119dzy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-1298-field_23-error\" required><\/div><div id=\"wpforms-1298-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_24\">a: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-1298-field_24-error\" required><\/div><div id=\"wpforms-1298-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_25\">przedmiot sporu: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-1298-field_25-error\" required><\/div><div id=\"wpforms-1298-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_18\">Wnosz\u0119 o przeprowadzenie mediacji. Okoliczno\u015bci\u0105 uzasadniaj\u0105c\u0105 wniosek jest:<\/label><textarea id=\"wpforms-1298-field_18\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"1298\" data-field-id=\"18\" data-text-limit=\"1000\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1298-field_18-error\" maxlength=\"1000\" >opis maksymalnie 1000 znak\u00f3w<\/textarea><\/div><div id=\"wpforms-1298-field_19-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_19\">Prosz\u0119\/o\u015bwiadczam \u017ce:<\/label><select id=\"wpforms-1298-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\"><option value=\"Wnosz\u0119 o skierowanie przez mediatora zapytania do drugiej strony o zgod\u0119 na mediacj\u0119.\"  selected='selected' class=\"choice-1 depth-1\"  >Wnosz\u0119 o skierowanie przez mediatora zapytania do drugiej strony o zgod\u0119 na mediacj\u0119.<\/option><option value=\"Wnioskodawca zobowi\u0105zuje si\u0119 podj\u0105\u0107 pr\u00f3b\u0119 uzyskania zgody od drugiej strony na mediacj\u0119.\"  class=\"choice-2 depth-1\"  >Wnioskodawca zobowi\u0105zuje si\u0119 podj\u0105\u0107 pr\u00f3b\u0119 uzyskania zgody od drugiej strony na mediacj\u0119.<\/option><option value=\"Druga strona wyrazi\u0142a zgod\u0119 na mediacj\u0119.\"  class=\"choice-3 depth-1\"  >Druga strona wyrazi\u0142a zgod\u0119 na mediacj\u0119.<\/option><\/select><\/div><div id=\"wpforms-1298-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Deklaruj\u0119 wniesienie zaliczki w kwocie 250,00 + 23% VAT = 307,50 z\u0142 na poczet wpisowego, w terminie 3 dni od dnia z\u0142o\u017cenia wniosku o przeprowadzenie mediacji, na konto:   Credit Agricole o\/Wroc\u0142aw nr 47 1940 1076 3083 7232 0000 0000   Kancelaria Mediacyjna &quot;Primum Consensus&quot;, Dorota Fedorowska   Plac Powsta\u0144c\u00f3w \u015al\u0105skich 17a, pok. 222, 53-329 Wroc\u0142aw   z dopiskiem: wniosek o przeprowadzenie mediacji z dnia ....\" aria-errormessage=\"wpforms-1298-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_20_1\">Deklaruj\u0119 wniesienie zaliczki w kwocie 250,00 + 23% VAT = 307,50 z\u0142 na poczet wpisowego, w terminie 3 dni od dnia z\u0142o\u017cenia wniosku o przeprowadzenie mediacji, na konto:   Credit Agricole o\/Wroc\u0142aw nr 47 1940 1076 3083 7232 0000 0000   Kancelaria Mediacyjna \"Primum Consensus\", Dorota Fedorowska   Plac Powsta\u0144c\u00f3w \u015al\u0105skich 17a, pok. 222, 53-329 Wroc\u0142aw   z dopiskiem: wniosek o przeprowadzenie mediacji z dnia ....<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1298-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_27\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_27_3\" name=\"wpforms[fields][27][]\" value=\"Zaliczka jest bezzwrotna i niezale\u017cna od koszt\u00f3w przeprowadzenia mediacji.\" aria-errormessage=\"wpforms-1298-field_27_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_27_3\">Zaliczka jest bezzwrotna i niezale\u017cna od koszt\u00f3w przeprowadzenia mediacji.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1298-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_28\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_28_4\" name=\"wpforms[fields][28][]\" value=\"Korzystaj\u0105c z formularza, zgadzasz si\u0119 na przechowywanie i przetwarzanie twoich danych przez witryn\u0119.\" aria-errormessage=\"wpforms-1298-field_28_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_28_4\">Korzystaj\u0105c z formularza, zgadzasz si\u0119 na przechowywanie i przetwarzanie twoich danych przez witryn\u0119.<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1298-field_2-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1298-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1298-field_2-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1298\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/new.fedorowska.pl\/index.php\/wp-json\/wp\/v2\/pages\/382\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1298\" class=\"wpforms-submit\" data-alt-text=\"Wysy\u0142ka\" data-submit-text=\"Wy\u015blij wniosek\" aria-live=\"assertive\" value=\"wpforms-submit\">Wy\u015blij wniosek<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/new.fedorowska.pl\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Wczytywanie\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Wniosek o Przeprowadzenie Mediacji INSTRUKCJA PRAWID\u0141OWEGO WYPE\u0141NIENIA WNIOSKU <style id=\"wpforms-css-vars-1298\">\n\t\t\t\t#wpforms-1298 {\n\t\t\t\t--wpforms-field-border-radius: 0px;\n--wpforms-field-border-color: #cccccc;\n--wpforms-field-border-color-spare: #cccccc;\n--wpforms-field-text-color: #444444;\n--wpforms-label-color: #262626;\n--wpforms-label-sublabel-color: #7f7f7f;\n--wpforms-label-error-color: #ff0000;\n--wpforms-button-border-style: solid;\n--wpforms-button-border-radius: 0px;\n--wpforms-button-background-color: #dddddd;\n--wpforms-button-border-color: #cccccc;\n--wpforms-button-text-color: #666666;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-page-break-color: #dddddd;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1298\"><form id=\"wpforms-form-1298\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1298\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/382\" data-token=\"72c1aa94300732da9f88f039d27cb6b7\" data-token-time=\"1786089594\"><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1298-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_1\">Imi\u0119 i nazwisko <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1298-field_1-error\" required><\/div><div id=\"wpforms-1298-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_4\">Adres (ulica, nr domu) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-1298-field_4-error\" required><\/div><div id=\"wpforms-1298-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_6\">Kod pocztowy i miejscowo\u015b\u0107 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-1298-field_6-error\" required><\/div><div id=\"wpforms-1298-field_29-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_29\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1298-field_29\" class=\"wpforms-field-medium wpforms-field-required\" data-disable-suggestions=\"1\" name=\"wpforms[fields][29]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1298-field_29-error\" required><\/div><div id=\"wpforms-1298-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_21\">Telefon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1298-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" aria-errormessage=\"wpforms-1298-field_21-error\" required><\/div><div id=\"wpforms-1298-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_8\">Imi\u0119 i nazwisko drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-1298-field_8-error\" required><\/div><div id=\"wpforms-1298-field_10-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_10\">Adres drugiego uczestnika sporu (ulica, nr domu) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-1298-field_10-error\" required><\/div><div id=\"wpforms-1298-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_11\">Kod pocztowy i miejscowo\u015b\u0107 drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1298-field_11-error\" required><\/div>\t\t<div id=\"wpforms-1298-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1298-field_2\" >Telefon sporu a:<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1298-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1298-field_12-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_12\">E-mail drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1298-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1298-field_12-error\" required><\/div><div id=\"wpforms-1298-field_22-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_22\">Telefon drugiego uczestnika sporu <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1298-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" step=\"any\" aria-errormessage=\"wpforms-1298-field_22-error\" required><\/div><div id=\"wpforms-1298-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_23\">W zwi\u0105zku z istniej\u0105cym sporem mi\u0119dzy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-1298-field_23-error\" required><\/div><div id=\"wpforms-1298-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_24\">a: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-1298-field_24-error\" required><\/div><div id=\"wpforms-1298-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_25\">przedmiot sporu: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1298-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-1298-field_25-error\" required><\/div><div id=\"wpforms-1298-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_18\">Wnosz\u0119 o przeprowadzenie mediacji. Okoliczno\u015bci\u0105 uzasadniaj\u0105c\u0105 wniosek jest:<\/label><textarea id=\"wpforms-1298-field_18\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"1298\" data-field-id=\"18\" data-text-limit=\"1000\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1298-field_18-error\" maxlength=\"1000\" >opis maksymalnie 1000 znak\u00f3w<\/textarea><\/div><div id=\"wpforms-1298-field_19-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1298-field_19\">Prosz\u0119\/o\u015bwiadczam \u017ce:<\/label><select id=\"wpforms-1298-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\"><option value=\"Wnosz\u0119 o skierowanie przez mediatora zapytania do drugiej strony o zgod\u0119 na mediacj\u0119.\"  selected='selected' class=\"choice-1 depth-1\"  >Wnosz\u0119 o skierowanie przez mediatora zapytania do drugiej strony o zgod\u0119 na mediacj\u0119.<\/option><option value=\"Wnioskodawca zobowi\u0105zuje si\u0119 podj\u0105\u0107 pr\u00f3b\u0119 uzyskania zgody od drugiej strony na mediacj\u0119.\"  class=\"choice-2 depth-1\"  >Wnioskodawca zobowi\u0105zuje si\u0119 podj\u0105\u0107 pr\u00f3b\u0119 uzyskania zgody od drugiej strony na mediacj\u0119.<\/option><option value=\"Druga strona wyrazi\u0142a zgod\u0119 na mediacj\u0119.\"  class=\"choice-3 depth-1\"  >Druga strona wyrazi\u0142a zgod\u0119 na mediacj\u0119.<\/option><\/select><\/div><div id=\"wpforms-1298-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Deklaruj\u0119 wniesienie zaliczki w kwocie 250,00 + 23% VAT = 307,50 z\u0142 na poczet wpisowego, w terminie 3 dni od dnia z\u0142o\u017cenia wniosku o przeprowadzenie mediacji, na konto:   Credit Agricole o\/Wroc\u0142aw nr 47 1940 1076 3083 7232 0000 0000   Kancelaria Mediacyjna &quot;Primum Consensus&quot;, Dorota Fedorowska   Plac Powsta\u0144c\u00f3w \u015al\u0105skich 17a, pok. 222, 53-329 Wroc\u0142aw   z dopiskiem: wniosek o przeprowadzenie mediacji z dnia ....\" aria-errormessage=\"wpforms-1298-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_20_1\">Deklaruj\u0119 wniesienie zaliczki w kwocie 250,00 + 23% VAT = 307,50 z\u0142 na poczet wpisowego, w terminie 3 dni od dnia z\u0142o\u017cenia wniosku o przeprowadzenie mediacji, na konto:   Credit Agricole o\/Wroc\u0142aw nr 47 1940 1076 3083 7232 0000 0000   Kancelaria Mediacyjna \"Primum Consensus\", Dorota Fedorowska   Plac Powsta\u0144c\u00f3w \u015al\u0105skich 17a, pok. 222, 53-329 Wroc\u0142aw   z dopiskiem: wniosek o przeprowadzenie mediacji z dnia ....<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1298-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_27\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_27_3\" name=\"wpforms[fields][27][]\" value=\"Zaliczka jest bezzwrotna i niezale\u017cna od koszt\u00f3w przeprowadzenia mediacji.\" aria-errormessage=\"wpforms-1298-field_27_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_27_3\">Zaliczka jest bezzwrotna i niezale\u017cna od koszt\u00f3w przeprowadzenia mediacji.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1298-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Potwierdzam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1298-field_28\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1298-field_28_4\" name=\"wpforms[fields][28][]\" value=\"Korzystaj\u0105c z formularza, zgadzasz si\u0119 na przechowywanie i przetwarzanie twoich danych przez witryn\u0119.\" aria-errormessage=\"wpforms-1298-field_28_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1298-field_28_4\">Korzystaj\u0105c z formularza, zgadzasz si\u0119 na przechowywanie i przetwarzanie twoich danych przez witryn\u0119.<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1298-field_2-container { position: absolute !important; 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