Ballot results for the candidate by precinct
| Candidate | Forysiak Henryk Józef |
| Age | 53 |
| Address and endorsements | Kazimierzew |
| Constituency no. | 4 |
| Number of votes for the candidate | 42 |
| % of valid votes for the candidate | 0.75% |
| Number of votes for the list | 566 |
| % of votes for the candidate relating to votes for the list | 7.42% |
| Mandate | No |
gm. Dalików
| No. | Address | Number of votes | % of valid votes* | Number of votes for the list | % of votes for the candidate relating to votes for the list * |
|---|---|---|---|---|---|
| 1 | Zespół Szkół w Dalikowie, ul. Łęczycka 3 | 1 |
0.15% 
|
43 |
2.33%
|
| 2 | Zespół Szkół w Domaniewie | 2 |
0.70%
|
35 |
5.71%
|
| 3 | Szkoła Podstawowa w Kucinach | 0 | — | 9 |
0.00%
|
| 4 | Remiza Ochotniczej Straży Pożarnej w Budzynku | 1 |
0.46%
|
40 |
2.50%
|
| 5 | Szkoła Podstawowa w Wilczycy | 0 | — | 9 |
0.00%
|
gm. Pęczniew
| No. | Address | Number of votes | % of valid votes* | Number of votes for the list | % of votes for the candidate relating to votes for the list * |
|---|---|---|---|---|---|
| 1 | Gimnazjum w Pęczniewie , Pęczniew, ul. Główna 15 | 4 |
0.53%
|
43 |
9.30%
|
| 2 | Remiza OSP w Luboli, Lubola 76 a | 7 |
3.35%
|
25 |
28.00%
|
| 3 | Remiza OSP w Księżej Wólce, Księża Wólka 28 | 2 |
1.05%
|
15 |
13.33%
|
| 4 | Szkoła Podstawowa w Drużbinie, Drużbin 54 | 0 | — | 20 |
0.00%
|
| 5 | Centrum Kulturalno - Oświatowe we wsi Brzeg przy Szkole Podstawowej, Brzeg 118 | 3 |
1.27%
|
23 |
13.04%
|
gm. Zadzim
| No. | Address | Number of votes | % of valid votes* | Number of votes for the list | % of votes for the candidate relating to votes for the list * |
|---|---|---|---|---|---|
| 1 | Szkoła Podstawowa w Zadzimiu | 13 |
2.20%
|
96 |
13.54%
|
| 2 | Sala OSP w Ralewicach | 7 |
1.99%
|
49 |
14.29%
|
| 3 | Szkoła Podstawowa w Zygrach | 1 |
0.21%
|
68 |
1.47%
|
| 4 | Szkoła Podstawowa w Małyniu | 0 | — | 21 |
0.00%
|
| 5 | Sala OSP w Wierzchach | 0 | — | 47 |
0.00%
|
| 6 | Sala OSP w Charchowie Pańskim | 1 |
0.37%
|
23 |
4.35%
|