Ballot results for the candidate by precinct
| Candidate | Surma Teresa |
| Age | 39 |
| Address and endorsements | Słupcza , endorsed by Samoobronę Rzeczpospolitej Polskiej |
| Constituency no. | 10 |
| Number of votes for the candidate | 53 |
| % of valid votes for the candidate | 17.91% |
| Number of votes for the list | 0 |
| % of votes for the candidate relating to votes for the list | — |
| Mandate | No |
gm. Dwikozy
| 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 * |
|---|---|---|---|---|---|
| 7 | Szkoła Podstawowa w Słupczy | 53 |
17.91% 
|
53 |
100.00%
|