Plné znění - 241/2006 Sb.

Questionnaire xxx the Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Provision xx Xxxxxxxxx Support xx Xxxxxxx of Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx of xxxxxxxx xxxx xxx xx xxxxxxxx certain xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx no. 209/1997. Xxxxx xxx xxx your cooperation; xx xx xxxxxx xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx in the xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. the xxxxxx xx xxx criminal xxx who has xxxxxxxx bodily xxxx, xx xxx survivor xx a xxxxxx xxx xxx xxxx xx consequence xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx x xxxxx xx attorney, xxxxxx fill in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx xx xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx authorizing him/her xx represent xxx xxxxxxxxx - x xxxx xx x xxxxx xx xxxxxxxx (xxx contractual representation) xx x copy xx xxx xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) or any xxxxx equivalent xxxxxxxx.

XXX. Xx the xxxxxxxxx xx x xxxxxxxx xx x person xxx xxx died xx consequenee of xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx the xxxxxxxx xxxx of xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Nationality:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxxx (x.x. xxxxxx, xxxxxxxx, xx xxxxxxxxxx xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx applicant is x survivor xx x xxxxxx who xxxx in xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx support the xxxxxxxx (xx the xxxx of a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or a xxxxx xxxxxxxx xx xxx obligation xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx attach a xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx on xxxxx xxx xxxxx was xxxxxxxxx xxx, if xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx x later xxxx, xxxxxx also xxxxxxx xxx xxxx xxx xxx manner xx which the xxxxxx learned xx xxxx xxxxxxxxxxxx (e.g., xxx xxxx of xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx authority (x.x. police, xxxxxx xxxxxxxxxx'x office, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx criminal proceedings. Xxxxx the xxxxxxxxx xxxxxx xx the xxxx related xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx attach xxx latest xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could indicate xxx xxxxx xx xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, copy xx xxx xxxxxxxxxx, xxxxxxxxx - final xx otherwise).

Xxxxxxxxx xx the provisions xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx xxx victim xxx xxxx xxx xx all legal xxxxxxxx xx enforce x claim for xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or any xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx identified.

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Fill xx xxxx XxXx if xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx in xxxxxxxxxxx of the xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, xxxxxx or xxxxx of the xxxxxx xxx died xx xxxxxxxxxxx of xxx xxxxxxxx xxxxxxx?

2. Xxx you xxxx xx a common xxxxxxxxx xxxx xxx xxxxxxxx person prior xx xxx commitment xx xxx crime?

3. Xxxx xxx a xxxxxxxxx xx xxx xxxxxx xx xxx xxx xxxxxxxx obliged xx support xxx?

4. Xx xxx xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx xxxxxx, xx xxxxx xx you.

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According xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, x xxxxxx who xx x xxxxxxxx xx x xxxxxx who xxxx in xxxxxxxxxxx xx a xxxxxxxx xxx is xxxxxxxxxx xx be x xxxxxx xx xx xx she xx x parent, xxxxxx xx child xx xxx xxxxxxxx and xxxxx xxxx xxx xx xxx in xxx xxxx household xx if xxx xxxxxx xxx x xxxxxxxxx of the xxxxxxxx or xxx xxxxxxxx was xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the xxxxxxxxx xx xxx xxxxxx xx x xxxxx xxx has xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx pain xxx xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx responsible for xxx xxxxxx'x treatment. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx only xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Act no. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act no. 209/1997, xx xxxxxxxxx xxxxxxx will be xxxxxxxx unless the xxxxx xxxxxxxxxx xx xxx xxxx xxxxxxxx xx xx least 100 points.

Xxx xxxxxx may xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxx xx CZK 25,000 or xx xxxxxx xxxxx xx xxx xxxxxx costs xx xxxxxxx treatment xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx a xx Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx a xxxx xxx xxxxxxx, xxxxx xx no need xx xxxx xx xxxxx XII - XxX.

Xxxx includes xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx by xx insurance company. xx such xxxxxxxx xxx xxx xxxxxx xx documentary xxxxxxxx, xxx Ministry xx Xxxxxxx may xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx documents xxxxxxxxxx xxxx xxxxx to xxx application.

If xxx xxxxxxxxx xx xx xxxxxxxx, these xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx amended. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be x xxxx xx xxx/xxx xxxx recent xxx xxxxxx. xx the xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx to xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx a document xxxxxxxxxx the xxxxxx xx xxx retirement xxxxxxx. lf for xxx xxxxxx xxx xxxxxxxxx'x income situation xxxxxx xx xxxxxx, xx exceptional cases xx xxxxxxxxx xxx xx attached.

Xx xxxxxx xxxxxxxx has xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx xx xxxxx I xxx x xxxxxx. X have xxx xxx xxxx xxxxxxxxxxx xxx xxx harm 1 xxxx suffered xx a xxxxxx xx the xxxxxxxx xxx.

X xxxxxx affirm xxxx I xxxx xxx lodged xxx xxxxx for financial xxxxxxx xx xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx suffered xx x result xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx xxxx the Xxxxx Republic.

I acknowledge xxxx xxxxxxxxx xx §12 xx Act Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx financial xxxxxxx xxx xxx xxxxxxx xx criminal xxxx xxx on amending xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx suffered, xx xx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx xxx xxxx-xxxx period, X xxx xxxx an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx provided xxxxxxx, xxxxxx xxxx a xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, xxx xxxxx extent xx xxxx suffered and xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx information xxx xxx purposes of xxxxxxxxxxxxx gaining xxxxxxxx xxx represent xx xxxxxxx xxxxxxxx xx §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 xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant to Xxx No. 209/1997, xxx Ministry of Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police or x xxxxxxx authority xx xxx xxx xxxxxxxx details xx xxx case. Xxxxxx xxxxx months xxxx xxx date xx xxx receipt of xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx support xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx be xxxxxxxxxx x victim as xxx Act Xx. 209/1997 Coll. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx xxxxxxxxxx xx a crime. X xxxxxxxxx but xxx xxx ohly xxxxxxxxx xxx the xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx (xxx xxx xxxxxxxxx of xxxxxx position), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx xxx has xxxx in consequence xx x xxxxx xxxxx be xxxxxxxxxx xx be a xxxxxx xx xxx xxxxxxxx xx x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx the xxxxxxxx xxxxxx a xxxxxxxxx xxxx the xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx or if xxx deceased xxxxxxxxx xx was xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx No. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx of xxxxxxxx xxxx xxxxxxxxxx a xxxxxxxxxx xxxx of 1 xxxx xxxx xxx date xx xxxxx the xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx. If xxxx xxxx xxxx xxx coincide xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx crime, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx xxxxxxx of xxx consequences. Xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for the xxxxxxxxx xx financial xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx xxxxx xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx xxxxxxx xxx xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx commitment of x crime xxx xx xx xxx xxxx xx a xxxx sum xxxxxxxxx xx CZK 25,000 xx an xxxxxx xxxxx to xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx by any xxxxxx previously xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx incurred. Xxx xxxxx amount xx xxxx support xxxx not xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx proves xxxx xxx xxxx suffered xxxxxxx the amount xxxxxxxx, xxx xxxxxx xxx xxxxxxx additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx xxxx xxx xxxx xx which xxx victim xxxxxxx xx the harm xxxxxx xx xxx xxxxx); in xxxx xxxx, any xxxxxxx xxxxxxx paid xxxx xx taken into xxxxxxx.

- An xxxxxxxxxx xxx is a xxxxxxxx xx x xxxxxx xxx xxx xxxx as x xxxxxx xx xxx xxxxxxxxxx xx a xxxxx (x parent, xxxxxx or xxxxx xx the xxxxxxxx xxxxxx xx x xxxxxx household xxxx xxx deceased xx xxx time of xxx/xxx xxxxx or xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx a xxxx sum amounting xx CZK 150,000. Xxx total xxxxxx xxxxxxxx as xxxxxxxxx xxxxxxx shall not xxxxxx CZK 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. does xxx replace xxx xxxxxxxxx xx xxx xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx xxxxxxx accidents, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should xxxx xx directed to xxx xxxxxxxx xxxxxxxxx xxxx liability insurance. Xxxx xx xxxxxxxx xxxxx, in xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx xxx xxxxxxxxx xx xxxxxxxxx support xx filed xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx xxxx xxxx xxx xxxxxxxxx documents xxx confirmations required xxx the xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx to xx so, xxx Xxxxxxxx xx Xxxxxxx xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx xxxx within x supplementary xxxxxxxx, xxxx xxxx xxx xxxxxxx a xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx xxxxxx any xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx xxx Ministry xx Justice xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx xx/xxx xxx xxx received xxx xxxxxxxxxxxx. If xx xxxxxxxxx xx xxx xxxxxx xx an xxxxxxxxxxx, the Ministry xx Xxxxxxx xxx xxxxx the xxxxx'x xxxxx to xxxxx xxx xxxxxx xx xxx xxxxxxxxx support xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx xxxx xx xxx victim.

Vážený pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Vás xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej činnosti xxxľx zákona č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx za xxxxxxxxxx, ktorú si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx x xxxxxxxľxxx - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

II. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx zákonného xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x plnej moci, xxxxxxx xxxxx x xxxxxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx xxx xxxxx, xxxx sa xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (pri xxxxxxxx xxxxxxxxx) alebo xxxxx rodného listu (x prípade zákonného xxxxxxxxxx) xxxxx inú xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx o umretej xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

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

Xx xx xxxxxxxľ osobou xxxxxxxxxx xx osobe, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx xxxxxxxx kópia xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx súdu x vyživovacej xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx bude xxxxxxx xxxx x pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx pošty alebo xxxxxxxx xx xxxxxxx xxxx; x takom xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx xxxxx, xxxx xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx činom.

Uveďte xxxxx xxxxxxxxx xxxxxxxxx xxxx x ak xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx naposledy xxxxx xxxxxxx x xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx ktorou prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (xxxx. uznesenie x xxxxxxxx trestného xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx ste xxxxxxxxx nárok xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, ktorá zodpovedá xx xxxxx.

Xxxľx ustanovenia §8 xxxxxx x. 209/1997 (Zb)., peňažitá xxxxx xx xôxx xxxxxx alebo xx xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx na xxxxxxxxxx xxxxxx na xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 xxxxxx č. 209/1997 Zb., xxxxxxxx xxľxx osôb spľňa xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

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

2. Xxxx ste s xxxxxx xxxxxxxxx xxxx xxxx xxxxxxxxx xxxxxxxxx xxxx x spoločnej xxxxxxxxxx?

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

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

Xxxľx xxxxxxxxxxx §2 xxxx. 2 zákona x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx, xx xx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XXX. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx ujma xx zdraví.

IX. Xxxxxx xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx skončila xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx ohodnotenia xx bolesť xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové ohodnotenie xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, xxxxx ho xxxxxxxxx. Tento lekársky xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 odst. 2 zákona x. 209/1997 Xx. xxxxxxx xxxxxxxxx' peňažnú xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx žiadate x poskytnutie xxxxxxxx xxxxxx vo xxxxx xxxxxxxxx xxxxxxx 25 000.- Xx xxxxx xx xxxxxxxx výšku ušlého xxxxxxx x xxxxxxxx xx liečenie.

Podľa ustanovenia §7 xxxx. 1 xxxx. x) zákona x. 209/1997 Zb. xx xxxxxxx obete xxxxx poskytnúť peňažnú xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo xx xxxxx zodpovedajúcej preukázaným xxxxxxxx xx xxxxxxxx x ušlému xxxxxxx. Xx xx xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx výške xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx body XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, zdravotnícke xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx náklady xx dopravu, x xxx. xxx podmienkou, xx tieto xxxxxxx xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx x xx xxxxxx ujmy xx xxxxxx xxôxxxxxxx trestným xxxxx.

X xxxxxxxx pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx o potvrdenie xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Zb., xxxxxxxx práce, x xxxxx neskorších predpisov. Xx xx xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx dokázať xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx prípade xx možné nahradiť xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

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

K xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx xxxxx xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx činom, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Xxxxx, xxxxx xx takto xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx peňažnú xxxxx xx obdobný xxxxx xx odškodnenie xxxx xxôxxxxxxx trestným xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx ako x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, že xx podľa xxx. §12 xxxxxx x. 209/1997 Xx., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x o zmene x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx neskorších xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx xxxxx, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx xxxxxx(x) xxx xxxxxxx škody, a xx až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx s xxx xxxxxx xx vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x mene štátu xxxxxx xxxxx na xxxxxxxx poskytnutej xxxxxx, xx moja sociálna xxxxxxxx xxxx taký xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, ktorú xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 odst. 1 písm. c) xxxxxx x. 200/1990 Xx., x priestupkoch, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Ministerstvo spravodlivosti Xxxxx republiky xx xxxxxxx žiadosti x xxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej príjem x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx okolností prípadu. Xx xxxxx mesiacov xx xxxxxx žiadosti x xxxxxxxxxx potrebných xxxxxxxx xxx pomoc xxxxxxxx alebo xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X zmysle zákona č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx za xxxx xxx x prípade, xx xx x xôxxxxxx trestného xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Nevyhnutnou, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie peňažnej xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 bodov. Xx xxxx sa považuje xx osoba xxxxxxxxx xx xxxxx, ktorá x xôxxxxxx trestného xxxx zomrela, xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň v xxxx jeho xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx zomretý xxxxxxxxxx xxxxx xxx xxxxxxx poskytovať výživu.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx peňažitej pomoci xxxxxxx trestnej xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 roka xxx xxx, keď xx xxxx xxxxxxxxx x škode spôsobenej xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx je xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, poskytne x xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx čiastok, xxxxx xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx tom, xxx jej poskytli xxxxx - preukáže, xx xxx vzniknutá xxxxx je xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, na xxx xxxxxxx v xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx xxxxx xxxxxxxxx pomoc xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx xx xxxxxxx, ktoré xx xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150 000.- Xx; xxxxx vo svojom xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x xx je xxxxx xxxxx xxxx xxx tri osoby, xxxxxxxxxxx xxxxxxx xx xxx každej obeti xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx je xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx nevyhnutné xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx skutočnosť xôxx byť dôvodom xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je do xxxxxxx xxxxx xxx xxx poskytnutia xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) až do xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx nemá, xx xx škodu xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx doby vzdať xxxxx xx vrátenie xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, celková xxxxx xxxxx, xxxxx jej xxôxxxxxx, a xxxxx xxxxxxx, xxxxx obeť xxxxxxx.