Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx No. 209/1997 Xxxx., xx xxx xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx of criminal xxxx and xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx xxx the xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Thank you xxx your cooperation; xx xx highly xxxxxxxxxxx.

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X. Please legibly xxxx in xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx the xxxxxxxx xxx who xxx xxxxxxxx xxxxxx harm, xx xxx survivor xx a xxxxxx xxx has died xx xxxxxxxxxxx of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

5. Mail xxxxxxxx xxxxxxx (xxxxxx xx diffen from xxx xxxxxxxxx xxxxxxx, xxxx):

6. Phone Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("representative") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx instance, x xxxxx xxxxx xxxxxxxxxxx xx his/her parent) xx on xxx xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx of xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx is xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx him/her xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of x xxxxx xx attorney (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx xxx xxxxx equivalent document.

III. Xx xxx xxxxxxxxx xx a xxxxxxxx xx a person xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxxx criminal xxx, please fill xx the xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx the applicant (x.x. xxxxxx, xxxxxxxx, xx individual xxxxxx xx common household)

If xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx consequence xx the xxxxxxxx xxx, please attach x xxxx xx xxx xxxxx xxxxxxxxxxx xxx any xxxxxxxxx xxxxxxx xxxx the xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx support the xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or x xxxxx xxxxxxxx xx xxx obligation xx xxxxxxx the dependent; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx xx which xxx crime was xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx the xxxxxxxxxxxx xx xxx crime xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx the xxxx xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx of xxxx xxxxxxxxxxxx (x.x., xxx date xx xxx medical xxxxxx).

XX. Xxxxxx specify xxx xxxxxxxx xxxxxxx authority (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx proceedings. Xxxxx xxx xxxxxxxxx xxxxxx xx xxx xxxx xxxxxxx xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx the abovementioned xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx stage xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx the indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the provisions xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx xxxx xxx xx xxx xxxxx xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx harm xxxxxxxx. Xx xxx xxxx xx this xxxx xx xxx xxxxxxxx has not xxxx xxxxxxxxxx.

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Xxxx xx xxxx VlIl if xxx xxxxxxxxx is x xxxxxxxx of xx xxxxxxxxxx xxx xxx died xx xxxxxxxxxxx xx the xxxxxxxxx xxxxx.

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

2. Xxx xxx xxxx xx a xxxxxx xxxxxxxxx with xxx xxxxxxxx xxxxxx xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

3. Xxxx xxx x xxxxxxxxx xx xxx xxxxxx xx was xxx xxxxxxxx obliged xx support you?

4. Xx xxx other xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Xxxxxx give xxxxx xxxxxx, xx xxxxx to xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 xx Xxx xx. 209/1997, a xxxxxx who xx x xxxxxxxx of x victim who xxxx xx xxxxxxxxxxx xx x criminal xxx xx considered xx be a xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx child of xxx xxxxxxxx xxx xxxxx xxxx him xx xxx xx xxx same xxxxxxxxx xx if the xxxxxx xxx a xxxxxxxxx of the xxxxxxxx xx xxx xxxxxxxx was xxxxxxxx xx support the xxxxxx.

Xx xxx applicant xx xxx xxxxxx xx x xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XXX.

Please attach x xxxxx-xxxxx xxxxxxxxxx xx pain and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x treatment. Xxxx medical report xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx of xxx pam xxxxxxxx xxx x point-based xxxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx that xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xx xxxxxxxx xxx the xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx of §6, section 2 xx Xxx no. 209/1997, xx financial xxxxxxx will be xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx xx xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx of CZK 25,000 xx xx xxxxxx equal xx xxx xxxxxx xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, section 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx x xxxx xxx xxxxxxx, xxxxx xx xx xxxx xx xxxx xx xxxxx XXX - XxX.

This includes xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx out xx xxx xxxx or xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx xxxx xxxxx have not xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Ministry of Xxxxxxx xxx xxx xxxx them into xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is xx xxxxxxxx, xxxxx documents xxxxx xxxxxxx x xxxxxxxxx from xxx/xxx xxxxxxxx describing xxx xxxxxxx salary according xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx document xxxxx xx a xxxx of his/her xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx to xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx xxx xxxxxx xx the xxxxxxxxxx xxxxxxx. lf xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx exceptional cases xx xxxxxxxxx may xx xxxxxxxx.

Xx xxxxxx xxxxxxxx has xxxx impaired as x xxxxxx xx xxx criminal act xx which I xxx x xxxxxx. X xxxx not xxx been xxxxxxxxxxx xxx xxx xxxx 1 xxxx xxxxxxxx xx a xxxxxx xx the criminal xxx.

X hereby xxxxxx xxxx I have xxx xxxxxx any xxxxx xxx xxxxxxxxx xxxxxxx or any xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx xx xxx xxxxxxx xxxxx xxxx xxx Xxxxx Republic.

I xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Act Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx the xxxxxxx xx xxxxxxxx acts xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx xxxxxxx to xxxxxxxxx the Xxxxxxxx xx Xxxxxxx xxx xxxxxx received xx xxxxxxxxxxxx for xxx xxxx suffered, xx xx xxx xxxxxx xx xxx financial xxxxxxx, xxxxxx xxxx xxxxx from the xxxx of receiving xxx funding xxxxxxx. X xxxx xxxxxxxxxxx xxxx, after the xxxxx of the xxxx-xxxx xxxxxx, I xxx file xx xxxxxxxxxxx asking the Xxxxxxxx xx Justice xx waive the xxxxx'x xxxxx xxx xxx return xx xxx xxxxxxxx support, xxxxxx such a xxxxxx be xxxx xxxxxxxx by my xxxxxx standing, the xxxxx extent xx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx of xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx c) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx xx xxx/xxx representative

- Upon xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx a serial xxxxxx. Subsequently, the Xxxxxxxx shall xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police xx x xxxxxxx authority xx xxx the xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx months xxxx xxx date xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx of the xxxxxxxxx documents, the Xxxxxxxx xxxxx either xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx xx the xxxxxxx xxx such xxxxxxx xxx been xxxxxxxx.

- Xxx xxxxxxxxx xxxxx be considered x xxxxxx as xxx Act Xx. 209/1997 Coll. xxxx xx he/she xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx xxxxxxxxxx xx x xxxxx. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx support xxxxx xx the xxxxxx xx xxx point-based xxxxxxxxxx of the xxx suffercd (xxx xxx weakening xx xxxxxx position), which xxxx be at xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx in consequence xx x xxxxx xxxxx be xxxxxxxxxx xx be x xxxxxx if the xxxxxxxx xx x xxxxxx, spouse xx xxxxx xx the xxxxxxxx xxx xxx xxxxxxxx xxxxxx a xxxxxxxxx with the xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx or xx xxx xxxxxxxx supported xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx of criminal xxxx stipulates x xxxxxxxxxx xxxx of 1 year xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx caused xx xxx xxxxx. If xxxx date xxxx xxx xxxxxxxx with xxx xxxx of xxx commitment xx xxx xxxxx, the xxxxxx xxxxx provide xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx meet an xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx the lapse xx the abovementioned xxxxxx.

- Financial xxxxxxx xx xxxxxxx xxx xx a xxxxxx xxx xxx suffered xxxxxx xxxx xx x xxxxxx of xxx commitment of x xxxxx may xx xx the xxxx of a xxxx sum xxxxxxxxx xx CZK 25,000 xx an amount xxxxx xx xxxx xxxxxx or xxx xxxxx xx xxxxxxx xxxxxxxxx xx proved xx the xxxxxx, xxxxxxx xx xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx. Xxx total amount xx such xxxxxxx xxxx not xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx amount xxxxxxxx, xxx xxxxxx xxx xxxxxxx additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx for xx within xxx xxxxxxxxxxxxxx xxxxxx of xxxx (x.x., 1 xxxx from xxx xxxx on which xxx victim xxxxxxx xx xxx xxxx xxxxxx xx the xxxxx); in xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx xx a xxxxxx xxx has xxxx as x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (x parent, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx xx xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx by the xxxxxxxx) shall xx xxxxxxxx xxxx x xxxx sum xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx as xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx number xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx xxx victim xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx related to xxxxxxxxxx liability xxxxxxxxx. Xx xxxxxxx related xx xxxxxxx accidents, xxxxxxxxxxxx for insurance xxxxxxxx xxxxxx xxxx xx directed xx xxx xxxxxxxx providing xxxx xxxxxxxxx insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx exceptional circumstances, xxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xx xxxxx with xxx Ministry xx Xxxxxxx.

- Xxxxxx xxxx xx xxxx that xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx the xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx the xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx application. Should xxx applicant xxxx xx deliver any xxxx documents xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx may xxxxxxx x decision xx xxxxxxxx xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, however, prejudice xxx filing of xxxxxxx xxxxxxxxxxx.

- Please xxxx xx xxxx xxxx xxx applicant xxxxx xx obliged xx xxxxxx any xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxxx (xxxx xxx xxxxxxxx, insurers etc.) xx xxx account xx xxx Xxxxxxxx xx Xxxxxxx up xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx so xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx the xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of xxx xxxx xxxxxxxx and xxx xxxxxx xx xxxxxxxxxxxx paid xx xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti o xxxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx činnosti xxxľx zákona č. 209/1997 Zb., xx však xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, ktorú si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx o xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej spôsobili xxxx xx zdraví, xxxxx xxxxx pozostalej xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx trvalého xxxxxx:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx iná xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) alebo xx xxxxxxx xxxxxx x plnej xxxx, xxxxxxx údaje o xxxxxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Preto x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo inú xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela, xxxxxxx, xxxxxx, xx xxxxx o xxxxxxx xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx činu x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx žijúca x xxxxxxxxx domácnosti):

Ak xx žiadateľ osobou xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela, x xxxxxxxx xx xxxx xxxxxxxx kópia xxxxxxxx xxxxx a xxxxxxx, xxxxx dokladajú xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x rodný xxxx xxxxx rozhodnutie súdu x xxxxxxxxxxx povinnosti, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x pod.)

IV. Xxxxxx, či xxxxxxx xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx trestného xxxx x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx a xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx zastupitelstvo, xxx), xxxxx xxxxxxxxx xxxxx konanie x xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx konaní, ktoré xxxx predstavu x xxx, x akom xxxxxx sa xxx xxxxxxxx (napr. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

VII. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx inej xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx prostriedky na xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx xxxxxxxxx uvedené x §2 odst. 2 xxxxxx x. 209/1997 Zb., prípadne xxľxx xxôx xxľxx xxxxx podmienky, xx xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx v xôxxxxxx xxxxxxxxx xxxx?

2. Xxxx xxx s xxxxxx xxxxxxxxx xxxx xxxx vykonaním trestného xxxx x xxxxxxxxx xxxxxxxxxx?

3. Xxxxxxxxxxx Vám xxxx trestného xxxx xxxxxx, či bola x xxxx povinná?

4. Xxľxxxx další xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Uveďte xxx počet, ak Xxx xx známy.

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx zomretého a xxxxxxx v xxxx xxxx xxxxx x xxx žila v xxxxxxxxxx alebo xxxxx, xxxxxx xxxxxx poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx xxxxxxxxx xxxx a xxxx xx xxôxxxxxx ujma xx zdraví.

IX. Uveďte xxxxx, xxxx xx xxxxxxxx liečenie, xxxxxxxxxx xxxx sa xxxxxxxx xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude obsahovať xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx a xxxxxx xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 odst. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' peňažnú xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx bolesti nedosiahne xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx žiadate x poskytnutie xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx xxxxx xx xxxxxxxx xxxxx xxxxxx xxxxxxx x xxxxxxxx xx liečenie.

Podľa ustanovenia §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť xxxxx xxxxx xxxxxxxxx peňažnú xxxxx xx xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x ušlému xxxxxxx. Xx xx rozhodnete xxxxxx o peňažnú xxxxx vo výške xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx na pomoc x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, x xxx. xxx podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx xxxxxxx, inak xx xx ministerstvo xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

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

X žiadosti pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx listinou xxxx napríklad xxxx xxxxxxxxxx daňového priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, že x xxxxxxxx závažného xôxxxx xxxxxxx xxxxxxx xxxxxxxxx pomery xxxxxxxľx, x xxxxxxx prípade xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ poberá, xx xxxxxxx xx vzniku xxxx na zdraví, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X prípade, xx v xôxxxxxx xxxxx xx xxxxxx xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx invalidný xôxxxxxx, xxxxxx x xxxxxxx jeho výšku.

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx takto xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx na peňažnú xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx som neuplatnil(a) x xxxxxxx xxxx xxxxx xxx v Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx podľa ust. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx x x xxxxx x x doplnení xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx pomoc, xxxxxxx xx xxxx Ministerstva xxxxxxxxxxxxxx xxxxxxx, ktoré xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx xx xx xxxxx poskytnutej xxxxxx. Xxxxxxx s xxx xxxxxx na xxxxxxx, xx po xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, xxx xx x mene xxxxx xxxxxx xxxxx xx xxxxxxxx poskytnutej pomoci, xx moja sociálna xxxxxxxx xxxx xxxx xxxxxx odôvodňovať, xxxxxxx xxxxx škody, xxxxx xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx vedomie, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 písm. x) xxxxxx č. 200/1990 Xx., x priestupkoch, x znení xxxxxxxxxx xxxxxxxxx.

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Potom bude xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx buď pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, prečo xxxxx nemožno xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx činu xxxx xxôxxxxxx poškodenie xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx výška xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx dieťaťom xxxxxxxxx x zároveň x xxxx jeho xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo xxx xxxxxxx poskytovať výživu.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx peňažitej xxxxxx xxxxxxx trestnej xxxxxxxx xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 roka xxx dňa, xxx xx obeť xxxxxxxxx x škode xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx dňom už xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx sa xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, ktoré xx xxxxxxxx po uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, ktorej v xôxxxxxx trestného xxxx xxxxxxx škoda xx xxxxxx, poskytne x xxxxxxxxx sume 25 000.- Xx xxxxx vo xxxxx, ktorá xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, preukázané xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx xxxxx už xxxxxxx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx sumu 150 000.- Xx. Ak xxxx - xx xxx, xxx jej poskytli xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx žiadosť x xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx opäť, x xx až xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx prihliadne xx xxxxxxx, xxxxx už xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx po obeti, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x čase xxxx xxxxx x xxx xxxx v xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, či xxx xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx xxxxxxx xxxxx v xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Xx, x xx xx xxxxx obetí xxxx xxx tri xxxxx, xxxxxxxxxxx xxxxxxx sa xxx každej obeti xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx povinné xxxxxxx poistenie zodpovednosti. Xxxxx je potrebné x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Len x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x potvrdenia, na xxxxx odkazujeme xxx xxxxxxxxxxxx položkách. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx x xxxxxxx ani dodatočne xxxxxx, táto xxxxxxxxxx xôxx xxx dôvodom xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx xx účet xxxxxxxxxxxx spravodlivosti xxxx, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne x xxx.) až do xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx mu xxxxx xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx štátu xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby vzdať xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx takýto postup xxôxxxxxxx xxxxxxxx situácia xxxxx, xxxxxxx výška xxxxx, xxxxx xxx xxôxxxxxx, a výška xxxxxxx, ktorú obeť xxxxxxx.