Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., on the xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxx xxxxxxx of xxxxxxxx xxxx xxx xx xxxxxxxx certain xxxxx xxxx, xx amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx for xxx xxxxx assessment xx xxxx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx support pursuant xx Xxx no. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please legibly xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx xxx xxxxxxxx xxx xxx has xxxxxxxx xxxxxx xxxx, xx the survivor xx a xxxxxx xxx xxx died xx consequence xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx of birth:

4. Xxxxxxxxx xxxxxxx:

5. Xxxx xxxxxxxx address (xxxxxx xx diffen from xxx permanent address, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx person ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx x xxxxx of xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx name:

3. Permanent xx registered xxxxxxx:

Xx xxx xxxxxxxxxxxxxx is xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx applicant, xxxxxx xxxx xxxxxx x xxxxxxxx authorizing xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx x xxxxx of xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx any xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, xxxxxx xxxx xx xxx personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Date xx xxxxx:

4. Xxxx of xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx xxx deceased xx xxx xxxxxxxxx (x.x. xxxxxx, daughter, xx xxxxxxxxxx xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x copy of xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx supported xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx xxx xxxx of x xxxxxx-xxxxx relationship, such xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx xx xxx obligation xx xxxxxxx the xxxxxxxxx; xx xxx case xx xxxxxxx xxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx xxx xxxxxxxxxxxx xx the xxxxx xx x later xxxx, please also xxxxxxx the xxxx xxx the xxxxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (e.g., xxx xxxx of xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx xxxxxxx xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx latest xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. resolution xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx may xx xxxxxxx xx xxxxxxxx depending xx xxxxxxx xxx xxxxxx xxx made use xx xxx xxxxx xxxxxxxx xx enforce x claim xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx xxx xxxxx person responsible xxx xxx xxxx xxxxxxxx. Do xxx xxxx in this xxxx if xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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

1. Xxx xxx a xxxxx, xxxxxx xx xxxxx xx xxx xxxxxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxx offence?

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

3. Xxxx you a xxxxxxxxx xx xxx xxxxxx xx was xxx xxxxxxxx obliged xx xxxxxxx xxx?

4. Xx any xxxxx xxxxxxx meet the xxxxxxxxxx described in xxxxxxx 1 xx 3? Xxxxxx give xxxxx xxxxxx, xx xxxxx to xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 of Act xx. 209/1997, a xxxxxx who is x survivor xx x xxxxxx xxx xxxx in xxxxxxxxxxx xx a criminal xxx xx xxxxxxxxxx xx be x xxxxxx xx he xx she xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx in xxx xxxx household xx if the xxxxxx xxx x xxxxxxxxx of the xxxxxxxx xx the xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

Xx xxx xxxxxxxxx xx the xxxxxx xx a xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx xxxxxxxx to Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx xx xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx medical xxxxxx xxxx xxxxxxx a xxxxx-xxxxx assessment xx xxx pam suffered xxx x xxxxx-xxxxx xxxxxxxxxx of the xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx only xxx xxxxx-xxxxx assessment xx the xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx xx xxx provisions xx §6, xxxxxxx 2 xx Act xx. 209/1997, xx financial xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxx xx XXX 25,000 or xx xxxxxx xxxxx to xxx proved costs xx medical treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). lf xxx xxxxxx xx apply xxx x lump xxx xxxxxxx, xxxxx xx xx xxxx xx xxxx in xxxxx XXX - XxX.

Xxxx includes xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx xxx in xxx xxxx or xxxx medical xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx documents xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx a xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx applicant xx xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx xx a xxxxxxx xxxxxx xxx xx able xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x document xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx for xxx reason the xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx exceptional xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x result of xxx criminal act xx which I xxx a xxxxxx. X xxxx xxx xxx been compensated xxx xxx xxxx 1 xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx xxxxxx any xxxxx xxx xxxxxxxxx xxxxxxx or any xxxxxxx claim for xxxxxxxxxxxx xxx xxx xxxx suffered as x xxxxxx xx xxx xxxxxxxx xxx xx xxx country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 xx Act Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx support xxx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx amending xxxxxxx xxxxx xxxx, xx amended, I xx xxxxxxx to xxxxxxxxx the Ministry xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx the xxxxxx xx xxx financial xxxxxxx, xxxxxx xxxx xxxxx from xxx xxxx of xxxxxxxxx xxx xxxxxxx support. X also xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx period, I xxx xxxx an xxxxxxxxxxx xxxxxx the Xxxxxxxx xx Xxxxxxx xx waive the xxxxx'x xxxxx for xxx return xx xxx provided xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, the xxxxx extent xx xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx received.

I also xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx for xxx xxxxxxxx of xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, xxxxxxx 1, xxxxxx x) of Xxx no. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx of xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx of xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx x serial xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx shall initiate xx xxxxxxxxxxxxx xxxx xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx xxx the xxxxxxxx xxxxxxx xx xxx case. Xxxxxx xxxxx months from xxx xxxx xx xxx xxxxxxx xx xxx application xxx xxxxxxxxxx of xxx xxxxxxxxx documents, the Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx why xxxx xxxxxxx has been xxxxxxxx.

- The xxxxxxxxx xxxxx be xxxxxxxxxx x victim xx xxx Xxx No. 209/1997 Coll. only xx xx/xxx xxx xxxxxxxx bodily harm xx a result xx the commitment xx x xxxxx. X xxxxxxxxx xxx xxx the xxxx xxxxxxxxx xxx xxx xxxxxx'x receipt xx xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx (xxx xxx xxxxxxxxx of xxxxxx position), xxxxx xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx of a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx the xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx xx xx xxx xxxxxxxx supported xx xxx xxxxxxxx xx support xxx xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx provision of xxxxxxxxx xxxxxxx xx xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx xxxx on xxxxx xxx xxxxxx xxxxxxx of the xxxx xxxxxx by xxx xxxxx. Xx xxxx date does xxx coincide xxxx xxx xxxx xx xxx commitment xx xxx crime, xxx xxxxxx xxxxx provide xxxxxxxx xx xxx xxxx on xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. The Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx for the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx for xx x xxxxxx xxx xxx xxxxxxxx xxxxxx harm xx x xxxxxx of xxx commitment xx x xxxxx xxx xx in the xxxx xx a xxxx sum amounting xx XXX 25,000 xx xx xxxxxx xxxxx to xxxx xxxxxx or xxx xxxxx xx medical xxxxxxxxx xx proved xx xxx xxxxxx, xxxxxxx by xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx compensation xxx xxx xxxx incurred. Xxx total amount xx xxxx xxxxxxx xxxx xxx exceed XXX 150,000. Xx, xxxxx xxx provision xx xxxxxxx, the xxxxxx proves xxxx xxx xxxx suffered xxxxxxx the amount xxxxxxxx, xxx victim xxx xxxxxxx additional xxxxxxx xx xx xxx amount of XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx the xxxxxxxxxxxxxx period of xxxx (i.e., 1 xxxx xxxx the xxxx on which xxx xxxxxx xxxxxxx xx xxx harm xxxxxx by the xxxxx); xx such xxxx, xxx amounts xxxxxxx paid xxxx xx xxxxx xxxx xxxxxxx.

- An individual xxx xx x xxxxxxxx xx x xxxxxx xxx has xxxx xx a xxxxxx of the xxxxxxxxxx xx x xxxxx (x xxxxxx, xxxxxx or child xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx at xxx time xx xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx the xxxxxxxx) shall be xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx shall not xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx victims exceed xxxxx, xxx amount xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act No. 209/1997 Xxxx. xxxx xxx replace xxx xxxxxxxxx of xxx xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx related to xxxxxxxxxx liability xxxxxxxxx. Xx matters xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx insurance xxxxxxxx should xxxx xx directed xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx filed xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx confirmations xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx to xx xx, xxx Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx any xxxx xxxxxxxxx and xxxxxxxxxxxxx xxxx within x supplementary deadline, xxxx fact may xxxxxxx x xxxxxxxx xx xxxxxxxx any xxxxxxx as xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, prejudice xxx xxxxxx xx xxxxxxx application.

- Please xxxx xx xxxx xxxx the xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx compensation for xxxx (from xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx account xx xxx Xxxxxxxx xx Justice xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx has xxx received any xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx in an xxxxxxxxxxx, the Ministry xx Justice xxx xxxxx the state's xxxxx xx xxxxx xxx return xx xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx the xxxxx xx xxx xxxx-xxxx xxxx, provided xxxx x waiver xx xxxxxxxxx by xxx victim's xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx the xxxx suffered xxx xxx xxxxxx of xxxxxxxxxxxx xxxx to xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Vás xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti o xxxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx zákona č. 209/1997 Zb., xx však vyplnenie xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx ceníme.

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I. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, xxxxxx spôsobili xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx xxxxxx (x xxxxxxx, že sa xxxx od xxxxxx xxxxxxxx xxxxxxxx):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje xxx xxxxx (zástupca) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx dohody x plnej moci, xxxxxxx údaje x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx x xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. X akom xxxxxx bola xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx k xxxxx žiadateľa (xxxx, xxxxx, xxxxx xxxxxx x spoločnej xxxxxxxxxx):

Xx xx xxxxxxxľ osobou xxxxxxxxxx xx osobe, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx, x xxxxxxxx xx xxxx priložiť kópia xxxxxxxx xxxxx a xxxxxxx, xxxxx dokladajú xxxxxxxxxx, xx xxxxxx xxxxx vyživovala xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - dieťa xôxxx x xxxxx xxxx xxxxx rozhodnutie súdu x xxxxxxxxxxx xxxxxxxxxx, xxx manželov takou xxxxxxxx bude xxxxxxx xxxx a xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; v xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx dátum, xxxx xx obeť xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx x ako (xxxxxxxxx z lekárskej xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx zastupitelstvo, xxx), ktorý xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx xxxx. Xxxxxx xx spisovú xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx konaní, xxxxx xxxx xxxxxxxxx x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x xxxxxxxx.

XXX. Xxxxxx, xxxx spôsobom xxx xxxxxxxxx xxxxx na xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, ktorá xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx sa xôxx xxxxxx alebo xx xxxxxxxx x xxxxxxxxxxxxx xx xx, či xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, ktorá xxxxxxxxx xx xxxxx. Xxxxx xxx nevyplňujte, ak xxxxxxxľx trestného činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx ste xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx uvedené x §2 odst. 2 xxxxxx x. 209/1997 Zb., xxxxxxxx xxľxx xxôx spľňa xxxxx podmienky, xx xx Vám xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx rodičom, xxxxxxxx xxxxx dieťaťom osoby, xxxxx xxxxxxx x xôxxxxxx trestného xxxx?

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

3. Poskytovala Xxx xxxx xxxxxxxxx xxxx xxxxxx, xx xxxx x xxxx povinná?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx podmienky 1 xx 3? Xxxxxx xxx počet, ak Xxx je xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť xxxxxxxx xxxxx pozostalá po xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx smrti x xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx sa xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x bola xx xxôxxxxxx xxxx xx zdraví.

IX. Uveďte xxxxx, kedy xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx skončila xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx musí xxxxxxxx bodové xxxxxxxxxxx xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý xx xxxxxxxxx. Tento lekársky xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x bodové xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

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

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. a) zákona x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx zodpovedajúcej preukázaným xxxxxxxx xx xxxxxxxx x ušlému xxxxxxx. Xx xx xxxxxxxxxx xxxxxx o peňažnú xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx body XXX. - XIV. xxxxx dotazníka.

XII. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx o náklady xx lieky, zdravotnícke xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx na xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. xxx podmienkou, xx tieto náklady xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, inak xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx xxxx x po xxxxxx ujmy xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, x xxxxx neskorších xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx starobného dôchodku. X prípade, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx prípade xx xxxxx nahradiť xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx nemocenských xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx ich xxxxxxxľ xxxxxx, či xxxxxxx xx vzniku xxxx xx zdraví, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx xx xxxxxx xxôxxxxxxx trestným xxxxx Xxx priznali invalidný xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx xxxxxx xx xxxx, že xxxxxxxx činom, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Škodu, xxxxx xx xxxxx xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx ako v Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx podľa ust. §12 xxxxxx č. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej činnosti x x xxxxx x o xxxxxxxx xxxxxxxxxx zákonov, x xxxxx neskorších xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx rokov odo xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx xx do xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x xxx xxxxxx na vedomie, xx xx xxxxxxxx xxxxxxxxxx päťročnej doby xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, xxx xx x mene xxxxx xxxxxx práva xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx sociálna xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx škody, xxxxx xx xxôxxxxxx x xxxxx xxxxxxx, ktorú xxx dostal(a).

Beriem xxxx xx vedomie, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. c) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx republiky xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx na xxxxxxx xx xx xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx prípadu. Xx troch xxxxxxxx xx xxxxxx žiadosti x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, prečo xxxxx xxxxxxx poskynúť.

- X zmysle zákona č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx peňažnej xxxxxx xxxxx obeti xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 bodov. Za xxxx sa xxxxxxxx xx osoba pozostalá xx obeti, ktorá x dôsledku xxxxxxxxx xxxx xxxxxxx, ak xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň x xxxx jeho xxxxx x ním žila x xxxxxxxxxx, alebo xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx xxxxxxxxxxx (prepadnú) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx. Ak xxxxx dňom xx xxx xx deň xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje okamžik, xxxx sa to xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx vyhovieť xxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx, ktoré mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx na xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx vo xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu na xxxxxxx, preukázané náklady xxxxxxx x liečením, xxxxxxx x súčet xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx xxxxx už xxxxxxx; xxxxx xx xxxxxx súčte xxxxxx xxxxxxxxxx sumu 150&xxxx;000.- Xx. Xx obeť - xx xxx, xxx jej poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx vyššia xxx tá, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx žiadosť x xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx pomoc opäť, x xx až xx maximálnej xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx už xxxx vyplatené.

- Xxxxxxxx xxxxx, ktorá je xxxxxxxxxx po obeti, xxxxx x dôsledku xxxxxxxxx činu zomrela (xx bola xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x čase xxxx xxxxx s xxx xxxx x xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, či bol xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx peňažná xxxxx x paušálnej xxxx 150&xxxx;000.- Kč; xxxxx xx xxxxxx xxxxx nesmie presiahnuť xxxx 450 000.- Kč, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je xxxxxxxx x xxxxxxxxxxxxxx dopravných xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x poskytnutie peňažnej xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx dostupné xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Ak xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, táto skutočnosť xôxx byť dôvodom xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je xx xxxxxxx xxxxx xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne a xxx.) až xx xxxxx poskytnutej xxxxxx. Xxxx povinnosť xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx uplynutí stanovenej xäxxxxxxx xxxx vzdať xxxxx xx vrátenie xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.