Fill in the registration form

Join the Programme to benefit from co-financing for the purchase of prescription drugs and pharmaceuticals and over-the-counter products available at the pharmacy.

If you do not receive within 30 minutes a confirmation of your application status, you may have entered an incorrect e-mail address. Please apply again!

The PESEL number indicates a minor, complete the application on behalf of the minor.

Parent details

Participant details

Child details

Attach a scan or photo of a document that confirms your PESEL number. *

Attach a scan or photo of a document that confirms your PESEL number. *

In order to verify the status of a Ukrainian citizen who came to Poland as a result of hostilities in Ukraine, please attach a document confirming the assignment of a PESEL number (the picture of document should include: first name, last name, citizenship, PESEL number, information or stamp or note on the “UKR” status, stamp and date of issue of the document, other data should be anonymised).  The document will be permanently deleted within 72 hours after the completion of verification of the application for the Programme in the case of accepted applications and within 21 days from the completion of verification in the case of rejected applications.

Captcha is required.

sign in

The website uses cookies in order to function properly and to use analytical tools. Detailed information on the purpose of their use and the conditions of their storage can be found in the Cookie Policy.