Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Applications xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support xx Xxxxxxx xx Criminal Xxxx pursuant xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx xxx the xxxxx assessment xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx you xxx xxxx xxxxxxxxxxx; xx is highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx in xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx xxx xxxxxxxx xxx who xxx xxxxxxxx xxxxxx harm, xx the survivor xx x person xxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx the xxxxx xx statutory representation (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx the xxxxx xx a xxxxx of xxxxxxxx, xxxxxx xxxx xx xxx data xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Permanent xx registered address:

If xxx xxxxxxxxxxxxxx xx xxxxxx xxx application xx behalf xx xxx xxxxxxxxx, please xxxx xxxxxx x xxxxxxxx authorizing him/her xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx the xxxxx xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx document.

III. Xx xxx applicant xx x xxxxxxxx xx a person xxx xxx xxxx xx consequenee of xxx respective xxxxxxxx xxx, xxxxxx fill xx xxx xxxxxxxx xxxx of xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxxx (x.x. father, daughter, xx xxxxxxxxxx xxxxxx xx xxxxxx household)

If xxx xxxxxxxxx is x xxxxxxxx xx x person xxx xxxx xx consequence xx the xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that the xxxxxxxx xxxxxxxxx xx xxx xx obligation xx xxxxxxx xxx xxxxxxxx (xx the xxxx of a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx a xxxxx decision on xxx xxxxxxxxxx to xxxxxxx xxx xxxxxxxxx; xx the xxxx xx xxxxxxx couples, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

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

VI. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx authority (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx recently xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx related xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx attach xxx latest decision xx the xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could xxxxxxxx xxx xxxxx xx xxx respective proceedings (x.x. resolution on xxx discontinuation xx xxxxxxxx prosecution, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx support xxx xx reduced or xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx made xxx xx xxx xxxxx xxxxxxxx to xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or xxx xxxxx person xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Do xxx xxxx xx xxxx xxxx if xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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

1. Xxx you x xxxxx, xxxxxx or xxxxx xx xxx xxxxxx xxx xxxx xx consequence of xxx xxxxxxxx xxxxxxx?

2. Xxx you xxxx xx x common xxxxxxxxx xxxx xxx xxxxxxxx person xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

3. Xxxx xxx x xxxxxxxxx xx xxx xxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxxxxxx xxx?

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

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 of Act xx. 209/1997, x xxxxxx who xx x xxxxxxxx xx x victim xxx xxxx in consequence xx x xxxxxxxx xxx xx considered xx xx a xxxxxx xx xx xx she is x xxxxxx, spouse xx xxxxx of xxx deceased and xxxxx xxxx xxx xx her xx xxx xxxx household xx xx the xxxxxx xxx x xxxxxxxxx of xxx xxxxxxxx xx the xxxxxxxx xxx xxxxxxxx xx support xxx xxxxxx.

Xx the xxxxxxxxx xx xxx victim xx a xxxxx xxx has suffered xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XXX.

Xxxxxx xxxxxx x point-based assessment xx xxxx and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx from xxx xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx pam suffered xxx a xxxxx-xxxxx xxxxxxxxxx of xxx xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx of §6, xxxxxxx 2 xx Act xx. 209/1997, no financial xxxxxxx will be xxxxxxxx unless xxx xxxxx xxxxxxxxxx of xxx xxxx suffered xx xx xxxxx 100 xxxxxx.

The xxxxxx may xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx xx CZK 25,000 or an xxxxxx xxxxx xx xxx xxxxxx costs xx xxxxxxx treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx to xxxxx xxx x xxxx xxx xxxxxxx, there xx xx xxxx xx fill xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx out in xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., provided xxxx xxxxx xxxx xxx xxxx xxxx by xx xxxxxxxxx company. xx such xxxxxxxx xxx xxx xxxxxx xx documentary xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx confirming xxxx xxxxx to xxx application.

If xxx xxxxxxxxx xx xx xxxxxxxx, these xxxxxxxxx xxxxx include x xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx amended. lf xxx applicant is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx xx his/her xxxx xxxxxx xxx xxxxxx. lf xxx xxxxxxxxx xx a xxxxxxx xxxxxx xxx xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx xxx amount xx the xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x income situation xxxxxx xx xxxxxx, xx xxxxxxxxxxx xxxxx xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x result xx xxx xxxxxxxx xxx xx xxxxx X xxx a xxxxxx. X have xxx xxx xxxx xxxxxxxxxxx xxx the xxxx 1 xxxx suffered xx x result xx the criminal xxx.

X xxxxxx affirm xxxx X have xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx or any xxxxxxx xxxxx xxx xxxxxxxxxxxx for the xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx xx any country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx to §12 of Act Xx. 209/1997 Coll., xx xxx provision xx financial support xxx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Xxxxxxx any xxxxxx received as xxxxxxxxxxxx xxx the xxxx xxxxxxxx, xx xx xxx amount xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx from xxx xxxx xx xxxxxxxxx xxx xxxxxxx support. X also acknowledge xxxx, xxxxx the xxxxx xx xxx xxxx-xxxx period, X xxx xxxx xx xxxxxxxxxxx asking xxx Xxxxxxxx of Justice xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx xx xxx provided xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx my xxxxxx standing, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx for xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx benefits xxx represent an xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx of xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx for xxx xxxxxxxxx of financial xxxxxxx xxxxxxxx to Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx shall xxxxxxx xxxxxxx and xxxxxx xx x serial xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx with xxx xxxxxx or x xxxxxxx xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx xxxxxx from xxx date of xxx xxxxxxx xx xxx application and xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx support xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx xxx such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx be xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx xxxxxxxxxx xx a xxxxx. X xxxxxxxxx but xxx xxx ohly xxxxxxxxx xxx xxx xxxxxx'x receipt of xxxxxxxx xxxxxxx xxxxx xx the amount xx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (not xxx xxxxxxxxx of xxxxxx position), which xxxx xx xx xxxxx 100 points. Xxxxxxxxx of a xxxxxx xxx has xxxx xx consequence xx x crime xxxxx be xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx xxx xxxxxxxx shared a xxxxxxxxx xxxx the xxxxxxxx at xxx xxxx of xxx/xxx xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx was xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx No. 209/1997 Coll. on xxx provision xx xxxxxxxxx support xx xxxxxxx of criminal xxxx xxxxxxxxxx a xxxxxxxxxx xxxx of 1 xxxx from xxx date on xxxxx xxx xxxxxx xxxxxxx of xxx xxxx xxxxxx xx xxx crime. Xx xxxx date xxxx xxx coincide with xxx date xx xxx xxxxxxxxxx xx xxx crime, the xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Justice xxxxxx meet xx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx for xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x xxxxx xxx xx xx xxx xxxx of a xxxx sum xxxxxxxxx xx CZK 25,000 xx an amount xxxxx xx xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx as xxxxxx xx xxx victim, xxxxxxx xx any xxxxxx previously paid xx the victim xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, the xxxxxx xxxxxx that xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx additional xxxxxxx up xx xxx xxxxxx of XXX 150,000 xx xx/xxx applies for xx within xxx xxxxxxxxxxxxxx xxxxxx of xxxx (x.x., 1 xxxx xxxx the xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx); in xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx is a xxxxxxxx xx x xxxxxx who xxx xxxx xx x xxxxxx of xxx xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx xx child xx xxx deceased xxxxxx in x xxxxxx household xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx or xxxxxxxxx xx xx xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx a xxxx xxx amounting xx XXX 150,000. Xxx total xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx the number xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx xxxxx xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx traffic accidents, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx thus xx directed xx xxx insurers xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx in xxxxxxxx xxxxx, xx view xx exceptional xxxxxxxxxxxxx, xxx an application xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. Xx xxx xxxxxxxxx fails xx xx so, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx xxxxxxxxxxx. Should xxx xxxxxxxxx fail xx xxxxxxx xxx xxxx documents and xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx application.

- Please xxxx xx mind xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx the Xxxxxxxx xx Xxxxxxx xx xx xxx xxxxxx xx xxx support xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx any xxxxxxxxxxxx. Xx xx xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx to claim xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx xxxxxxxx after the xxxxx xx the xxxx-xxxx xxxx, xxxxxxxx xxxx x waiver xx xxxxxxxxx by xxx victim's xxxxxx xxxxxxxx, xxx total xxxxxx xx xxx xxxx suffered xxx xxx xxxxxx of xxxxxxxxxxxx paid xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Xxx za xxxxxxxxxx, ktorú xx xxxxx ceníme.

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I. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx x žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx rodičom) alebo xx základe xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Preto k xxxxxxxx priložte xxxxx xxxxx xxxx (xxx xxxxxxxx zastúpení) alebo xxxxx rodného listu (x prípade zákonného xxxxxxxxxx) alebo xxx xxxxxxx xxxxxxx.

XXX. Ak xxxxxxxľ xxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela, xxxxxxx, xxxxxx, xx xxxxx x xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

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

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx xxxxxxxx xxxxx xxxxxxxx listu a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx mala xxxxxxxxx ju vyživovať (xx xxxxxx xxxxx - xxxxx pôjde x rodný xxxx xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx xxxxxxx xxxx x pod.)

IV. Xxxxxx, či žiadate xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx na xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx oznámte xxxxx Xxxxx xxxx.

X. Xxxxxx xxxxx, xxxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx dátum xxxxxxxxx xxxxxxxxx činu x ak xx xxxx o škode xxx xxôxxxxxxx xxxxxxxxx xx neskôr, xxxxxx xxxx x xxx (xxxxxxxxx z xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

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

Xx xxxx x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx činného x xxxxxxxx konaní, ktoré xxxx xxxxxxxxx x xxx, x akom xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x žiadosti.

VII. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx škody xx xxxxxxxľx alebo xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Zb)., peňažitá xxxxx sa xôxx xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx na xxxxxxxxxx xxxxxx na xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu. Xxxxx xxx nevyplňujte, ak xxxxxxxľx trestného činu xxxxxxxxx.

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

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, ktorá xxľxx podmienky uvedené x §2 odst. 2 zákona x. 209/1997 Xx., xxxxxxxx xxľxx xxôx spľňa xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Boli xxx rodičom, xxxxxxxx xxxxx xxxxxxxx osoby, xxxxx zomrela x xôxxxxxx trestného xxxx?

2. Xxxx xxx s xxxxxx xxxxxxxxx xxxx xxxx xxxxxxxxx trestného xxxx v xxxxxxxxx xxxxxxxxxx?

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

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

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť xxxxxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx zomretého x xxxxxxx v xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx alebo osoba, xxxxxx xxxxxx poskytoval xxxxx bol povinný xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Vyplňte, xx sa žiadateľ xxxx xxxxxx trestného xxxx x xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, kedy sa xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx sa skončila xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx sa xxxx xxxxxxxx xxxxxx ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude obsahovať xxxxxx hodnotenie xxxxxxxxx xxxxxxx a xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx bodové xxxxxxxxxxx xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 bodov.

XI. Xxxxxx, či žiadate x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx xxxxx či xxxxxxxx výšku ušlého xxxxxxx a xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť xxxxx xxxxx poskytnúť peňažnú xxxxx vo xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na xxxxxxxx x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, nemusíte xx xxxxxxxxx body XXX. - XIV. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x liečením xxxxxx:

Xxx o náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady na xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x xxxxxxxxxx xx xxxxxxxxxx, zvýšené náklady xx xxxxxxx, a xxx. pod podmienkou, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx sa xxxxx xxxxxxx, inak xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

XIII. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré xxxxxxxxxx xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x nasl. zákona x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx napríklad xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ poberá xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom prípade xx xxxxx xxxxxxxx xxxxxxxxxx x nich xxxxxxx vyhlásením.

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

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. V xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným činom Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx a xxxxxxx jeho výšku.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx činom, ktorého xxx bol(a) xxxxxx, xx moja xxxxxxxx xxxxxxxx zhoršila. Škodu, xxxxx xx takto xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx podľa xxx. §12 zákona x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti x x xxxxx x o xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, keď xx xxxxxxxx pomoc, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx xx do xxxxx poskytnutej xxxxxx. Xxxxxxx x tým xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx päťročnej doby xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx poskytnutej xxxxxx, xx moja sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, xxxxx xxx dostal(a).

Beriem tiež xx vedomie, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx xxxxxx získania xxxxxxxxxxxx xxxxxx, sa xôxxx dopustiť priestupku xxxľx §21 xxxx. 1 xxxx. c) xxxxxx č. 200/1990 Xx., x xxxxxxxxxxxx, x znení xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx 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 xxxx xxxxxxxxxx xx xxxxxxx xx na xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx xxxxxx žiadosti x xxxxxxxxxx potrebných xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx dôvody, xxxxx xxxxx nemožno poskynúť.

- X xxxxxx zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx mu v xôxxxxxx trestného xxxx xxxx spôsobené poškodenie xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx bodového xxxxxxxxxxx xxxxxxx (nie xxxx sťaženie spoločenského xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx obeti, ktorá x xôxxxxxx xxxxxxxxx xxxx zomrela, xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx jeho smrti x xxx xxxx x domácnosti, alebo xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, keď xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx mu xxxxxxxx po xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx škoda xx xxxxxx, xxxxxxxx x xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx vo xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx čiastok, ktoré xxxx z titulu xxxxxxx škody xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - po tom, xxx jej xxxxxxxx xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx xx vyššia xxx xx, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx žiadosť v xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx xxxxx xxxxxxxxx pomoc opäť, x to xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; pričom xx prihliadne na xxxxxxx, xxxxx xx xxxx vyplatené.

- Fyzickej xxxxx, ktorá xx xxxxxxxxxx xx obeti, xxxxx v dôsledku xxxxxxxxx xxxx zomrela (xx bola xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx poskytovať xxxxxx), xx poskytne xxxxxxx xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx vo xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x ak je xxxxx xxxxx xxxx xxx tri xxxxx, xxxxxxxxxxx xxxxxxx xx xxx každej xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx je xxxxxxxx x záležitostiach dopravných xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx xxxxxxx. Xxx x xxxxxx ojedinelých xxxxxxxxx s prihliadnutím xx konkrétne výnimočné xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx xxxxxxxxxx xôxx xxx dôvodom xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx podať xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ je xx xxxxxxx xxxxx odo xxx xxxxxxxxxxx pomoci xxxxxxx na účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx do xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx xxxx, xx mu škodu xxxxxxxxxx. Xx xxxxxxx xxxxxxxx obete xx xxxxxxxxxxxx spravodlivosti môže x xxxx xxxxx xx uplynutí stanovenej xäxxxxxxx xxxx vzdať xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx takýto xxxxxx xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.