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I hereby submit the above-mentioned scientific arti- cle for publication in the PFRON Quarterly "Disability - issues, problems, solutions&#34

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(place, date)

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(academic title, name and surname, correspondence address, telephone number, e-mail of the Author submitting the article)

STATEMENT

I declare* that I have read* the Code of Publishing Ethics for authors submitting their scien- tific articles for publication in the Quarterly "Disability - issues, problems, solutions" (ISSN 2084-7734), the Publisher of which is the State Fund for the Rehabilitation of Disabled Peo- ple, and that I undertake to abide by these principles.

I also declare that I am the Author/Co-author* of a scientific article entitled:

...

...

which does not infringe the copyrights of others or is not submitted to the selection proce- dure in any other publishing procedure. I hereby submit the above-mentioned scientific arti- cle for publication in the PFRON Quarterly "Disability - issues, problems, solutions" published by the State Fund for Rehabilitation of Disabled People based in Warsaw, Al. Jana Pawła II, no. 13.

Concurrently, I grant PFRON a free license to use the above-mentioned scientific article as a whole or in part, by its publishing and reproduction in any form and by any means, particu - larly in printed and electronic versions, in any number of copies, for an indefinite period of time, on the premises of Poland and beyond the borders.

I hereby acknowledge that I can withdraw the above-mentioned scientific article from the publishing process without any consequences until it is submitted to reviewers. In case where I withdraw the above-mentioned and positively reviewed scientific article, I am obliged to reimburse the costs incurred by the Publisher related to the review procedure.

……….………..

(signature of the Author submitting the article)

* delete as appropriate

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