Plné znění - 241/2006 Sb.

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

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx the xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx xxx xxx xxxx cooperation; xx xx xxxxxx xxxxxxxxxxx.

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

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx person ("representative") xx the xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx instance, x xxxxx xxxxx xxxxxxxxxxx xx his/her xxxxxx) xx xx the xxxxx xx x xxxxx of xxxxxxxx, xxxxxx fill in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx registered xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx submit x xxxxxxxx xxxxxxxxxxx xxx/xxx xx represent xxx xxxxxxxxx - a xxxx xx x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx representation) xx x xxxx xx the xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx the xxxxxxxxx xx x xxxxxxxx xx a xxxxxx xxx has died xx consequenee of xxx xxxxxxxxxx xxxxxxxx xxx, please fill xx xxx personal xxxx of the xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Nationality:

7. Xxxxxxxxxxxx xx the deceased xx the xxxxxxxxx (x.x. father, xxxxxxxx, xx individual xxxxxx xx common xxxxxxxxx)

Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx attach x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or a xxxxx decision on xxx obligation xx xxxxxxx the dependent; xx xxx xxxx xx xxxxxxx couples, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx on which xxx xxxxx was xxxxxxxxx xxx, if xxx victim learned xxxxx xxx consequences xx the crime xx x xxxxx xxxx, please also xxxxxxx xxx date xxx the manner xx xxxxx the xxxxxx learned xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx of xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx the xxxxxxxxx xxxxxx xx the xxxx xxxxxxx to xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx attach xxx latest xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could indicate xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx prosecution, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

According xx xxx provisions xx §8 of Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx or xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx xxxx xxx xx all xxxxx xxxxxxxx to enforce x claim xxx xxxxxxxxxxxx against xxx xxxxxxxx xx xxx xxxxx xxxxxx responsible xxx the harm xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx not xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx xx xxx applicant xx x xxxxxxxx xx xx xxxxxxxxxx who xxx xxxx in xxxxxxxxxxx xx the xxxxxxxxx xxxxx.

1. Xxx you x xxxxx, spouse or xxxxx xx xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxxxxxx?

2. Xxx xxx live xx a common xxxxxxxxx with the xxxxxxxx person xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

3. Xxxx xxx x xxxxxxxxx of the xxxxxx xx xxx xxx xxxxxxxx obliged xx xxxxxxx xxx?

4. Xx any xxxxx xxxxxxx meet the xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx number, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 of Act xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx xx x victim who xxxx xx xxxxxxxxxxx xx a xxxxxxxx xxx is considered xx be x xxxxxx xx xx xx xxx xx x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx and xxxxx with xxx xx xxx xx xxx same xxxxxxxxx xx xx xxx xxxxxx was x xxxxxxxxx of xxx xxxxxxxx or xxx xxxxxxxx xxx required xx xxxxxxx xxx xxxxxx.

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

Please xxxxxx x xxxxx-xxxxx xxxxxxxxxx xx pain and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx from the xxxxxxxxx xxxxxxxxxxx for xxx victim's treatment. Xxxx xxxxxxx report xxxx xxxxxxx x xxxxx-xxxxx assessment xx xxx xxx suffered xxx x xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x xxxxxx position. Xxxxxx xxxx xx xxxx xxxx xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx xx xxxxxxxx xxx the purposes xx Act xx. 209/1997. According to xxx provisions xx §6, section 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 sum financial xxxxxxx xx xxx xxxxxx xx XXX 25,000 xx xx xxxxxx equal to xxx proved xxxxx xx medical xxxxxxxxx xxx xxxx income (§7, xxxxxxx 1, xxxxxx a xx Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx to xxxxx xxx x lump xxx xxxxxxx, there xx xx xxxx xx fill xx xxxxx XXX - XxX.

Xxxx includes xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx not xxxxxx xx documentary evidence, xxx Xxxxxxxx of Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx confirming xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. lf the xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx xx xxxxx his/her xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the amount xx the xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx xxxxxxxxxxx cases xx xxxxxxxxx may xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x xxxxxx of xxx xxxxxxxx xxx xx xxxxx X xxx a xxxxxx. X xxxx not xxx xxxx compensated xxx xxx harm 1 xxxx suffered xx x xxxxxx xx xxx criminal xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx xxxxxx xxx xxxxx xxx financial xxxxxxx or any xxxxxxx xxxxx for xxxxxxxxxxxx for xxx xxxx xxxxxxxx xx x xxxxxx xx xxx criminal xxx xx xxx country xxxxx than xxx Xxxxx Republic.

I xxxxxxxxxxx xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Xxxx., xx xxx provision xx xxxxxxxxx xxxxxxx xxx the victims xx xxxxxxxx xxxx xxx xx amending xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx the Xxxxxxxx xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxx xxxx suffered, xx xx the xxxxxx xx xxx xxxxxxxxx xxxxxxx, xxxxxx five xxxxx xxxx the xxxx xx xxxxxxxxx xxx funding support. X also acknowledge xxxx, after xxx xxxxx xx the xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx asking the Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x xxxxx xxx xxx return xx xxx xxxxxxxx support, xxxxxx such x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, the xxxxx xxxxxx of xxxx xxxxxxxx and xxx amount xx xxxxxxxxxxxx received.

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

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Xxxxxxxxx xx xxx applicant xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx the xxxxxxxxxxx xxx the xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Xxxxxxxx of Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx x serial xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx investigation xxxx xxx xxxxxx xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx details xx xxx xxxx. Within xxxxx xxxxxx xxxx xxx date xx xxx xxxxxxx of xxx xxxxxxxxxxx xxx xxxxxxxxxx of the xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- The xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Act Xx. 209/1997 Xxxx. xxxx xx xx/xxx has xxxxxxxx bodily xxxx xx x xxxxxx xx xxx commitment xx x crime. X xxxxxxxxx but xxx the ohly xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx support xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (not xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx be xx xxxxx 100 points. Xxxxxxxxx xx a xxxxxx xxx has xxxx xx consequence xx a xxxxx xxxxx xx xxxxxxxxxx xx be x xxxxxx if xxx xxxxxxxx is x xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx xxx the xxxxxxxx xxxxxx x xxxxxxxxx xxxx the xxxxxxxx xx the xxxx xx xxx/xxx xxxxx xx if xxx deceased supported xx xxx xxxxxxxx xx support xxx xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx provision xx xxxxxxxxx xxxxxxx to xxxxxxx of xxxxxxxx xxxx stipulates x xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx xx xxxxx the xxxxxx xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx. If xxxx xxxx xxxx xxx xxxxxxxx with xxx date of xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx consequences. The Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx for xx a xxxxxx xxx xxx suffered xxxxxx xxxx xx x xxxxxx xx xxx commitment of x crime xxx xx in xxx xxxx of x xxxx xxx xxxxxxxxx xx XXX 25,000 xx xx amount xxxxx to xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx xx xxxxxx xx xxx xxxxxx, xxxxxxx by any xxxxxx xxxxxxxxxx paid xx the xxxxxx xx compensation for xxx xxxx xxxxxxxx. Xxx total xxxxxx xx xxxx support xxxx not xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx support, the xxxxxx xxxxxx xxxx xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx receive additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx applies xxx xx within xxx xxxxxxxxxxxxxx period of xxxx (x.x., 1 xxxx from xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx paid will xx taken into xxxxxxx.

- An xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx as x xxxxxx of the xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx xx x xxxxxx household xxxx xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xxxxxxxxx xx xx xxxxxxxx to be xxxxxxxxx by xxx xxxxxxxx) xxxxx be xxxxxxxx xxxx x xxxx xxx amounting xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx the number xx xxxxxxx exceed xxxxx, xxx xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx liability xxxxxxxxx. Xx matters related xx traffic xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx in xxxxxxxx xxxxx, in xxxx xx exceptional xxxxxxxxxxxxx, xxx xx application xxx the provision xx xxxxxxxxx support xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please xxxx xx xxxx that xxx xxxxxxxxx xxxxxxxxx xxx confirmations xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx to xxx xxxxxxxxxxx. Xx the xxxxxxxxx fails xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx even xxxxxx x supplementary xxxxxxxx, xxxx fact xxx xxxxxxx a xxxxxxxx xx withhold xxx xxxxxxx as per Xxx No. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx filing of xxxxxxx xxxxxxxxxxx.

- Please xxxx in mind xxxx the xxxxxxxxx xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx compensation for xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx the Xxxxxxxx xx Justice xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. If so xxxxxxxxx by the xxxxxx in an xxxxxxxxxxx, xxx Ministry xx Justice xxx xxxxx the xxxxx'x xxxxx xx xxxxx xxx return of xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx by xxx xxxxxx'x social xxxxxxxx, xxx total xxxxxx xx the xxxx suffered and xxx xxxxxx xx xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Vážený pán/pani/slečna

Ospravedlňujeme xx, že v xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx posúdenia Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x žiadateľovi - obeti trestného xxxx, ktorej xxôxxxxxx xxxx na xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

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

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx xxx osobu, xxxx xx doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte xxxxx xxxxx xxxx (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x prípade zákonného xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx činu x xxxxx xxxxxxxľx (xxxx, xxxxx, osoba xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx xxxxxxxx xxxxx xxxxxxxx listu x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo mala xxxxxxxxx ju vyživovať (xx xxxxxx xxxxx - xxxxx pôjde x rodný xxxx xxxxx rozhodnutie súdu x vyživovacej xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx xxxxxxx xxxx a pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo oznámte xxxxx Vášho xxxx.

X. Xxxxxx xxxxx, xxxx xx obeť dozvedela x škode spôsobenej xxxxxxxx xxxxx.

Xxxxxx dátum xxxxxxxxx xxxxxxxxx xxxx x ak sa xxxx x škode xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx xxxx. Xxxxxx xx xxxxxxx xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx konaní, xxxxx xxxx xxxxxxxxx x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx trestného xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

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

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

Xxx XXXX. Vyplňte, xx žiadateľ je xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

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

1. Boli xxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx činu?

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

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

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

Xxxľx xxxxxxxxxxx §2 odst. 2 zákona x. 209/1997 Xx. sa xx obeť považuje xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx zomretého a xxxxxxx x xxxx xxxx xxxxx x xxx žila x xxxxxxxxxx alebo xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx ujma xx xxxxxx.

XX. Uveďte xxxxx, xxxx sa xxxxxxxx liečenie, xxxxxxxxxx xxxx xx skončila xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx bodového xxxxxxxxxxx xx bolesť xxxx:

X xxxxxxxx sa musí xxxxxxxx xxxxxx ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx od xxxxxx, xxxxx xx xxxxxxxxx. Tento xxxxxxxx xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely zákona č. 209/1997 Zb. je xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 odst. 2 xxxxxx x. 209/1997 Zb. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx bodové ohodnotenie xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx xx výške xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s liečením xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx na xxxxx x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx tieto xxxxxxx xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, inak xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx a xx xxxxxx ujmy xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x nasl. xxxxxx x. 262/2006 Zb., xxxxxxxx práce, x xxxxx xxxxxxxxxx predpisov. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx napríklad xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, xx x xxxxxxxx závažného xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx možné xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx vyhlásením.

XIV. Uveďte xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, odkedy ich xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. X prípade, xx v dôsledku xxxxx na zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx a xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) obeťou, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx odškodnenie xxxx spôsobenej xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx vedomie, xx xx xxxľx xxx. §12 xxxxxx x. 209/1997 Zb., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, xxx mi xxxxxxxx xxxxx, xxxxxxx xx xxxx Ministerstva xxxxxxxxxxxxxx čiastky, xxxxx xxx xxxxxx(x) xxx xxxxxxx škody, x xx až xx xxxxx poskytnutej xxxxxx. Xxxxxxx x xxx xxxxxx xx vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx dostal(a).

Beriem xxxx xx vedomie, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx neúplného údaja xx xxxx zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, sa xôxxx xxxxxxxx priestupku xxxľx §21 xxxx. 1 písm. x) xxxxxx č. 200/1990 Xx., o priestupkoch, x znení neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Ministerstvo spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx na xxxxxxx xx xx inom xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx xxxxx žiadateľovi xxxxxx dôvody, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx v xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx činu xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie peňažnej xxxxxx xxxxx obeti xx xxxxx bodového xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx spoločenského xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Za xxxx sa xxxxxxxx xx xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx dieťaťom zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx žila x domácnosti, alebo xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx trestnej xxxxxxxx xxxxxxxxx xxxxxxxxxxx (prepadnú) xxxx 1 roka xxx xxx, xxx xx xxxx dozvedela x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx dňom už xxx xx deň xxxxxxxxx xxxxxxxxx činu, xxxx dokazuje xxxxxxx, xxxx xx to xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx vyhovieť žiadostiam x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx škoda xx xxxxxx, xxxxxxxx v xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx vo xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx na xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx x súčet xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx škody xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - po xxx, xxx xxx poskytli xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx xx xxxxxx xxx xx, xxxxx xxxx podkladom xx xxxxxxxxxxx xxxxxx, na xxx xxxxxxx v xxxxxx stanovenej xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx prihliadne xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx bola xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx xxxxx x ním xxxx x domácnosti, xxxxx xxx zomretý xxxxxxxxxx, či xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx peňažná xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x xx xx xxxxx xxxxx viac xxx tri osoby, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx subjekt, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s prihliadnutím xx konkrétne xxxxxxxxx xxxxxxxxx xx možné xxxxxx ministerstvo spravodlivosti x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx xxxxxxx x potvrdenia, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx spravodlivosti nemôže xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, táto xxxxxxxxxx xôxx byť xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx peňažná pomoc, xxxxxxxľ xx xx xxxxxxx xxxxx xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne a xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx uplynutí stanovenej xäxxxxxxx xxxx xxxxx xxxxx na vrátenie xxxxxxxxxxx xxxxxxxx pomoci. Xx xxxxxx postup xxôxxxxxxx sociálna situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, ktorú xxxx xxxxxxx.