\documentclass[a4paper,11pt]{article}
\usepackage[polish]{babel}
\usepackage[utf8]{inputenc} 
\usepackage[T1]{fontenc}
\usepackage{fourier}

\begin{document}

\noindent
\makebox[8cm]{Imię i nazwisko: \dotfill}\\
\makebox[6cm]{Data urodzenia: \dotfill}\\
Adres zamieszkania: \dotfill

\end{document}