Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Xxxxxxxxxx xx Applications xxx xxx Provision of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx to Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx fulancial xxxxxxx xx the xxxxxxx of xxxxxxxx xxxx and xx xxxxxxxx certain xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx xx xxxx current xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx xxxxxxxxxxxxx xx xxxxxxxx for the xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support xxxxxxxx xx Xxx no. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

_____________________________________________________________________________________________

X. Xxxxxx legibly xxxx xx the xxxxxxxx xxxx of xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx xxx xxx xxxxxxxx bodily xxxx, xx the xxxxxxxx xx x person xxx has xxxx xx xxxxxxxxxxx of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx xxxxxxx:

5. Xxxx xxxxxxxx address (xxxxxx xx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx, xxxx):

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx applicant xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("representative") xx the xxxxx xx statutory xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx parent) xx on xxx xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx xxxx in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx name:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, please xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx the xxxxxxxxx - x xxxx xx x xxxxx xx attorney (xxx xxxxxxxxxxx representation) xx a xxxx xx xxx xxxxx xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx a person xxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxxx criminal xxx, please xxxx xx the personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx the xxxxxxxxx (x.x. xxxxxx, daughter, xx individual xxxxxx xx common xxxxxxxxx)

Xx xxx applicant is x xxxxxxxx of x xxxxxx xxx xxxx in consequence xx xxx xxxxxxxx xxx, xxxxxx attach x copy of xxx death xxxxxxxxxxx xxx any xxxxxxxxx xxxxxxx that the xxxxxxxx supported xx xxx xx obligation xx support xxx xxxxxxxx (xx the xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx on xxx obligation to xxxxxxx xxx xxxxxxxxx; xx xxx case xx xxxxxxx couples, xxxxxx attach x xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify the xxxx xx which xxx xxxxx xxx xxxxxxxxx and, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx the crime xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx xxx date xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx medical report).

VI. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx authority (x.x. police, public xxxxxxxxxx'x office, court) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx proceedings. Xxxxx xxx xxxxxxxxx xxxxxx of the xxxx xxxxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx the xxxxxxxxxxxxxx xxxxxxxx justice xxxxxxxxx xxxxx xxxxx indicate xxx xxxxx xx xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx on xxx discontinuation xx xxxxxxxx prosecution, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx otherwise).

According xx xxx xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx reduced xx xxxxxxxx xxxxxxxxx on xxxxxxx the victim xxx made use xx xxx legal xxxxxxxx xx xxxxxxx x xxxxx for xxxxxxxxxxxx against xxx xxxxxxxx or any xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

______________________________________________________________________________________________

Xxxx xx xxxx XxXx xx xxx applicant xx x xxxxxxxx of xx individual xxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, spouse xx xxxxx xx xxx xxxxxx xxx xxxx xx consequence of xxx xxxxxxxx offence?

2. Xxx you live xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx person xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

3. Xxxx xxx x xxxxxxxxx of the xxxxxx or xxx xxx deceased xxxxxxx xx xxxxxxx xxx?

4. Xx xxx xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Please give xxxxx number, if xxxxx xx you.

______________________________________________________________________________________________

According xx xxx provisions xx §2, xxxxxxx 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx of x victim who xxxx xx xxxxxxxxxxx xx x xxxxxxxx xxx xx considered xx be a xxxxxx if xx xx xxx is x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx xxxxx with xxx xx her in xxx xxxx xxxxxxxxx xx xx xxx xxxxxx was x xxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxx xxx required xx support the xxxxxx.

Xx the xxxxxxxxx xx xxx xxxxxx xx x xxxxx xxx xxx xxxxxxxx xxxxxx harm, please xxxx xx xxxxx XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx should be xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx contain a xxxxx-xxxxx assessment xx xxx xxx xxxxxxxx xxx a xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx that only xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx is relevant xxx xxx xxxxxxxx xx Act xx. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx of §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx will xx xxxxxxxx unless xxx xxxxx assessment of xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx the xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx to xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx a xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx to xxxxx xxx a xxxx xxx xxxxxxx, xxxxx xx no need xx xxxx xx xxxxx XXX - XxX.

Xxxx includes xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx xxx xx xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx paid xx xx xxxxxxxxx company. xx such expenses xxx xxx xxxxxx xx documentary evidence, xxx Xxxxxxxx of Xxxxxxx xxx not xxxx xxxx into xxxxxxxxxxxxx.

Xxxxxx attach xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx application.

If xxx xxxxxxxxx xx xx xxxxxxxx, xxxxx documents xxxxx include a xxxxxxxxx xxxx his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Act xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx xxxxxxx. lf xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be x xxxx of his/her xxxx xxxxxx xxx xxxxxx. lf xxx xxxxxxxxx xx a xxxxxxx person who xx able xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx x xxxxxxxx xxxxxxxxxx xxx xxxxxx xx xxx retirement xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be xxxxxx, xx exceptional xxxxx xx affidavit may xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx xxx xx xxxxx I xxx x xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx the xxxx 1 xxxx xxxxxxxx xx x result xx the xxxxxxxx xxx.

X xxxxxx affirm xxxx X xxxx xxx lodged xxx xxxxx xxx financial xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx the xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx act xx any xxxxxxx xxxxx than xxx Xxxxx Republic.

I xxxxxxxxxxx xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx xxxxxxxxx support xxx xxx xxxxxxx xx criminal acts xxx xx amending xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx xxxxxxx to xxxxxxxxx the Xxxxxxxx xx Justice any xxxxxx xxxxxxxx as xxxxxxxxxxxx for xxx xxxx xxxxxxxx, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx funding xxxxxxx. X xxxx acknowledge xxxx, xxxxx xxx xxxxx of xxx xxxx-xxxx xxxxxx, I xxx xxxx an xxxxxxxxxxx xxxxxx the Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x xxxxx xxx xxx xxxxxx xx xxx provided support, xxxxxx such a xxxxxx xx xxxx xxxxxxxx xx my xxxxxx standing, xxx xxxxx extent xx xxxx xxxxxxxx xxx xxx amount of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx information xxx xxx xxxxxxxx xx xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

-----------------------------------------------------------------

Xxxxxxxxx of xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant xx Xxx No. 209/1997, xxx Ministry xx Xxxxxxx xxxxx confirm xxxxxxx xxx assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx with xxx xxxxxx xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx details xx xxx xxxx. Xxxxxx xxxxx months xxxx xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx either xxxxxxx xxx xxxxxxx xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx xxxxxxxxxx x victim xx xxx Xxx No. 209/1997 Xxxx. xxxx xx xx/xxx has xxxxxxxx bodily xxxx xx a result xx the xxxxxxxxxx xx a crime. X necessary xxx xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx support xxxxx xx the xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx (xxx xxx weakening of xxxxxx position), which xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx who xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx x xxxxxx, spouse or xxxxx xx the xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Act No. 209/1997 Xxxx. on xxx provision xx xxxxxxxxx xxxxxxx xx xxxxxxx xx criminal xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 year from xxx date xx xxxxx the victim xxxxxxx of xxx xxxx xxxxxx xx xxx crime. Xx xxxx xxxx does xxx xxxxxxxx with xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx xxxxx provide xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. The Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx x xxxxxx xxx xxx suffered xxxxxx harm xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx xxx xx xx the xxxx xx x xxxx xxx amounting xx XXX 25,000 xx xx amount xxxxx to xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx by xxx xxxxxx previously xxxx xx xxx xxxxxx xx compensation for xxx harm xxxxxxxx. Xxx total xxxxxx xx such xxxxxxx xxxx not xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx that xxx xxxx xxxxxxxx xxxxxxx xxx amount xxxxxxxx, xxx victim xxx receive xxxxxxxxxx xxxxxxx xx xx xxx amount xx XXX 150,000 xx xx/xxx xxxxxxx for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx the xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); xx such xxxx, xxx xxxxxxx xxxxxxx paid xxxx xx taken xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx xx x xxxxxx who has xxxx as x xxxxxx xx the xxxxxxxxxx xx a xxxxx (x xxxxxx, xxxxxx xx child xx the deceased xxxxxx xx x xxxxxx household with xxx deceased xx xxx time of xxx/xxx xxxxx or xxxxxxxxx xx xx xxxxxxxx to xx xxxxxxxxx by the xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx sum xxxxxxxxx xx XXX 150,000. Xxx total xxxxxx xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, the amount xxxxxxxx per xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. does xxx xxxxxxx xxx xxxxxxxxx xx the xxxxxxxxx liability xx xxxxxxxxx xx motor xxxxxxxx xxxxxxx to xxxxxxxxxx liability insurance. Xx matters xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx to xxx insurers xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx in xxxxxxxx xxxxx, in view xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xx filed xxxx xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx bear xx xxxx that xxx available xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx so, the Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx fail xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx a xxxxxxxx xx withhold any xxxxxxx xx xxx Xxx No. 209/1997 Xxxx. This shall xxx, however, prejudice xxx xxxxxx xx xxxxxxx application.

- Please xxxx in mind xxxx xxx xxxxxxxxx xxxxx be xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx compensation xxx xxxx (from xxx xxxxxxxx, xxxxxxxx etc.) xx the xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx amount xx xxx support xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx apply xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. If so xxxxxxxxx xx the xxxxxx in xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx state's xxxxx to xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx term, provided xxxx x waiver xx xxxxxxxxx xx xxx victim's xxxxxx xxxxxxxx, the total xxxxxx xx xxx xxxx xxxxxxxx and xxx amount xx xxxxxxxxxxxx xxxx xx xxx victim.

Vážený pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx posúdenia Xxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

______________________________________________________________________________________________

X. Xxxxxx, xxxxxxx xxxxxxľxx osobné xxxxx o xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx pozostalej xx xxxxx, ktorá x xôxxxxxx trestného xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx trvalého pobytu:

5. Xxxxxxxxxxxxxx xxxxxx (v xxxxxxx, xx xx xxxx xx xxxxxx xxxxxxxx xxxxxxxx):

6. Telefón:

7. X-Xxxx:

8. Občianstvo:

II. Ak xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx rodičom) alebo xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx sa xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx inú xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx xx osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, aj xxxxx x xxxxxxx xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx po osobe, xxxxx v dôsledku xxxxxxxxx činu xxxxxxx, x žiadosti sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo mala xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx a xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx pošty alebo xxxxxxxx xx xxxxxxx xxxx; x takom xxxxxxx xxxxxxx oznámte xxxxx Xxxxx xxxx.

X. Xxxxxx dátum, kedy xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x xx xx xxxx x xxxxx xxx spôsobenej xxxxxxxxx xx xxxxôx, uveďte xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx x xxxxxxxx konaní (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx naposledy xxxxx konanie o xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného v xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, x akom xxxxxx xx xxx xxxxxxxx (xxxx. uznesenie x odložení trestného xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx na xxxxxxx škody xx xxxxxxxľx alebo inej xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa xxxxxxxxxxx §8 zákona č. 209/1997 (Xx)., peňažitá xxxxx xx xôxx xxxxxx alebo xx xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx xx osobe, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, či xxx xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx xxôx spľňa xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

1. Boli xxx rodičom, manželom xxxxx xxxxxxxx osoby, xxxxx xxxxxxx x xôxxxxxx trestného činu?

2. Xxxx xxx s xxxxxx xxxxxxxxx činu xxxx xxxxxxxxx xxxxxxxxx xxxx x spoločnej xxxxxxxxxx?

3. Poskytovala Xxx xxxx trestného xxxx xxxxxx, xx xxxx x tomu povinná?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx podmienky 1 xx 3? Uveďte xxx xxxxx, xx Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx činu xxxxxxx, xx je xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

______________________________________________________________________________________________

Xxxx XX. xx XXX. Xxxxxxx, xx sa xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx x bola xx xxôxxxxxx xxxx xx xxxxxx.

XX. Xxxxxx xxxxx, kedy sa xxxxxxxx xxxxxxxx, respektíve xxxx sa skončila xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx xx musí xxxxxxxx xxxxxx ohodnotenie xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx od xxxxxx, xxxxx ho xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 bodov.

XI. Xxxxxx, xx xxxxxxx x xxxxxxxxxxx peňažnej xxxxxx xx xxxxx xxxxxxxxx čiastky 25&xxxx;000.- Xx xxxxx xx xxxxxxxx výšku ušlého xxxxxxx x nákladov xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx žiadosť xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, alebo xx xxxxx zodpovedajúcej preukázaným xxxxxxxx xx xxxxxxxx x ušlému zárobku. Xx sa xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx čiastky, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x liečením xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx pomoc x domácnosti či xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. xxx xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx xxxx na xxxxxx spôsobenej xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ je x zamestnaneckom pomere, xôxxx o potvrdenie xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx samostatne zárobkovo xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx starobného dôchodku. X xxxxxxx, xx x nejakého xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx možné xxxxxxxx xxxxxxxxxx x nich xxxxxxx vyhlásením.

XIV. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx poisťovne x xxxxx nemocenských xxxxx. X xxxxxxx, xx v dôsledku xxxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx xxxx xxxxx.

Xxxx majetkové pomery xx také, že xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx moja sociálna xxxxxxxx zhoršila. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx peňažnú xxxxx xx obdobný xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx som xxxxxxxxxx(x) x žiadnom inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx vedomie, že xx xxxľx xxx. §12 zákona č. 209/1997 Zb., x xxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x doplnení xxxxxxxxxx zákonov, v xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, keď mi xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x xxx xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx práva na xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx odôvodňovať, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, ktorú xxx xxxxxx(x).

Xxxxxx tiež xx xxxxxxx, že xxxxxxxxx xxxxxxxx nesprávneho xxxxx xxxxxxxxx xxxxx xx xxxx xxxxxxxxx xx xxxxxx získania xxxxxxxxxxxx xxxxxx, sa xôxxx xxxxxxxx priestupku xxxľx §21 xxxx. 1 písm. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

------------------------------------------

xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx po xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx poradové xxxxx. Xxxxx bude xxxxxxxxxx na xxxxxxx xx xx inom xxxxxxxx orgáne podľa xxxxxxxxxxx okolností xxxxxxx. Xx xxxxx mesiacov xx podaní žiadosti x predložení xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx dôvody, xxxxx xxxxx xxxxxxx poskynúť.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx xx x xôxxxxxx trestného činu xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx sťaženie spoločenského xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx sa xxxxxxxx xx xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xxxx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx alebo bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx obeť dozvedela x xxxxx xxôxxxxxxx xxxxxxxx činom. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx činu, xxxx dokazuje xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx žiadostiam x poskytnutie peňažnej xxxxxx, ktoré xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, ktorej v xôxxxxxx trestného činu xxxxxxx škoda xx xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25 000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z titulu xxxxxxx škody xx xxxxxxx; pomoc xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx tom, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx xx xxxxxx xxx tá, ktorá xxxx podkladom na xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx stanovenej xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx opäť, x to xx xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, ktorá xx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x zároveň x čase xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne peňažná xxxxx x paušálnej xxxx 150 000.- Kč; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Kč, x ak xx xxxxx xxxxx xxxx xxx tri osoby, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx vozidiel, na xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx žiadať xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s prihliadnutím xx konkrétne výnimočné xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx peňažná pomoc, xxxxxxxľ xx xx xxxxxxx xxxxx odo xxx poskytnutia xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne a xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx vrátenie xxxxxxxxxxx peňažnej xxxxxx. Xx takýto postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, a výška xxxxxxx, xxxxx obeť xxxxxxx.