| bill to the contract for specific work | rachunek do umowy o dzielo |
| personal data of taxpayer/taxpayer's personal data | dane podatnika |
| mother's first name | imie matki |
| date and place of birth | data i miejsce ur |
| National Identification Number | nr PESEL |
| middle name | drugie imie |
| last/second name | trzecie imie |
| taxpayer's Identification number | NIP |
| commune/district/residence | gmina/dzielnica |
| county | powiat |
| voivodship | wojewodztwo |
| house number | nr domu |
| flat number | lokal |
| postcode | kod pocztowy |
| locality | miejscowosc |
| bill dated/bill as of ... (date) | rachunek z dnia |
| contractor | wykonawca |
| orderer | zamawiajacy |
| located at/in ... street | z siedziba w ... przy ulicy |
| for the perfomed work | za wykonanie czynnosci |
| pursuant to/in line with/according to/as described/as stipulated contract | zgodnie z umowa |
| gross amount | kwota rachunku brutto |
| tax deductible | koszty uzyskania przychodu |
| taxible base | podstawa opodatkowania |
| tax pre-payment/pre-paid count tax | zaliczka na podatek dochodowy |
| amount payable | kwota do wyplaty |
| say | slownie |
| I've received the said amount | wymieniona kwote otrzymalem |
| signature | podpis |