Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx of Criminal Xxxx xxxxxxxx to Xxx No. 209/1997 Xxxx., on the xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, as amended

Dear Xxx/Xxxxx,

Xx apologise for xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx in xxxx xxxxxxx situation. Xxxxxxx, filling in xxxx questionnaire xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx for xxx provision of xxxxxxxxx support xxxxxxxx xx Xxx no. 209/1997. Xxxxx xxx xxx xxxx cooperation; xx xx highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in the xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. the xxxxxx xx xxx xxxxxxxx xxx xxx has xxxxxxxx xxxxxx harm, xx the xxxxxxxx xx x xxxxxx xxx xxx xxxx xx consequence xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx his/her xxxxxx) xx xx xxx xxxxx xx x xxxxx xx attorney, xxxxxx xxxx xx xxx data xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx registered address:

If xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx applicant, please xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx contractual xxxxxxxxxxxxxx) xx x copy xx xxx xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx any xxxxx equivalent document.

III. Xx xxx xxxxxxxxx xx a xxxxxxxx xx x person xxx xxx died xx consequenee of xxx respective criminal xxx, xxxxxx xxxx xx the personal xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxxx (x.x. father, xxxxxxxx, xx individual living xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx in consequence xx xxx criminal xxx, xxxxxx xxxxxx x copy xx xxx death certificate xxx xxx xxxxxxxxx xxxxxxx xxxx the xxxxxxxx supported xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx xxx xxxx of a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx or x xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx a xxxxx xxxx, xxxxxx xxxx xxxxxxx xxx xxxx xxx xxx xxxxxx xx which xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (e.g., xxx date xx xxx xxxxxxx report).

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

Xx xxxxxxxxx, please xxxxxx xxx latest decision xx the xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could xxxxxxxx xxx stage xx xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, copy xx the indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx amount xx xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx xxxx use xx xxx xxxxx xxxxxxxx to enforce x xxxxx xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or xxx xxxxx xxxxxx xxxxxxxxxxx xxx the xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx has not xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx if xxx xxxxxxxxx xx x survivor of xx individual xxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxxx crime.

1. Xxx xxx x xxxxx, xxxxxx or xxxxx xx xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxxxxxx?

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

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

4. Xx xxx xxxxx xxxxxxx xxxx xxx xxxxxxxxxx described xx xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx number, if xxxxx to xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 xx Xxx xx. 209/1997, x xxxxxx who is x xxxxxxxx of x victim who xxxx xx xxxxxxxxxxx xx x xxxxxxxx xxx is xxxxxxxxxx xx xx x xxxxxx xx xx xx she xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx with xxx xx xxx in xxx same xxxxxxxxx xx xx xxx xxxxxx xxx x xxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxxxx was xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the applicant xx xxx xxxxxx xx x crime xxx xxx xxxxxxxx xxxxxx xxxx, please xxxx in xxxxx XX - XIV.

Please xxxxxx x xxxxx-xxxxx assessment xx pain xxx xxxxxxxxx xxxxxxxx to Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx for xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xxx x point-based xxxxxxxxxx of the xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx in xxxx that xxxx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Xxx no. 209/1997. According to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain suffered xx xx least 100 xxxxxx.

Xxx xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx xxx xxxxxx xx CZK 25,000 or xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx medical treatment xxx xxxx xxxxxx (§7, section 1, xxxxxx a of Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx a xxxx xxx xxxxxxx, xxxxx xx xx xxxx xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx out in xxx xxxx xx xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx not xxxx paid xx xx insurance xxxxxxx. xx xxxx expenses xxx xxx xxxxxx xx documentary xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx into xxxxxxxxxxxxx.

Please xxxxxx xxx documents xxxxxxxxxx xxxx xxxxx xx xxx application.

If xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Act xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx applicant xx xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx xx his/her xxxx recent tax xxxxxx. lf xxx xxxxxxxxx xx x xxxxxxx xxxxxx who xx able to xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx x document xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. lf for xxx xxxxxx the xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be proven, xx xxxxxxxxxxx cases xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x xxxxxx of xxx criminal xxx xx xxxxx X xxx x xxxxxx. X xxxx xxx xxx been xxxxxxxxxxx xxx the harm 1 xxxx suffered xx a xxxxxx xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx X have xxx xxxxxx xxx xxxxx xxx financial xxxxxxx xx xxx xxxxxxx claim xxx xxxxxxxxxxxx xxx the xxxx xxxxxxxx as x xxxxxx of xxx xxxxxxxx xxx xx xxx xxxxxxx xxxxx than xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according to §12 xx Xxx Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx xxx xxxxxx xx the financial xxxxxxx, xxxxxx xxxx xxxxx xxxx the xxxx xx xxxxxxxxx xxx xxxxxxx support. X xxxx acknowledge xxxx, xxxxx xxx xxxxx of the xxxx-xxxx xxxxxx, X xxx file xx xxxxxxxxxxx asking xxx Xxxxxxxx of Xxxxxxx xx waive xxx xxxxx'x xxxxx xxx xxx return xx xxx xxxxxxxx xxxxxxx, xxxxxx such a xxxxxx be xxxx xxxxxxxx xx my xxxxxx xxxxxxxx, the xxxxx extent of xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

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

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Signature of xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx the xxxxxxxxxxx for xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx shall xxxxxxx xxxxxxx and xxxxxx xx x serial xxxxxx. Subsequently, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx of xxx receipt xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx either xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx why xxxx xxxxxxx xxx been xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Act No. 209/1997 Xxxx. only xx he/she has xxxxxxxx bodily xxxx xx x result xx xxx xxxxxxxxxx xx x xxxxx. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx xxx the xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx point-based xxxxxxxxxx xx xxx xxx suffercd (xxx xxx xxxxxxxxx of xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx a xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxx the xxxxxxxx xxxxxx a xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx xx if xxx deceased xxxxxxxxx xx xxx required xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx date on xxxxx xxx xxxxxx xxxxxxx of the xxxx xxxxxx xx xxx xxxxx. Xx xxxx date xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx commitment xx xxx crime, xxx xxxxxx shall xxxxxxx xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx learned xx xxx xxxxxxxxxxxx. The Xxxxxxxx xx Xxxxxxx xxxxxx xxxx an xxxxxxxxxxx for the xxxxxxxxx xx financial xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx applied xxx xx x xxxxxx xxx xxx suffered xxxxxx harm as x xxxxxx xx xxx commitment xx x crime may xx xx xxx xxxx xx a xxxx xxx amounting xx XXX 25,000 xx xx xxxxxx xxxxx xx lost xxxxxx xx xxx xxxxx of medical xxxxxxxxx xx proved xx the victim, xxxxxxx by xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx harm xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. If, xxxxx xxx provision xx xxxxxxx, xxx xxxxxx proves that xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx up xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx within xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx the xxxx on which xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx amounts xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx x xxxxxxxx xx a xxxxxx who xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx child xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx time of xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx be xxxxxxxx with x xxxx sum xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx number xx victims xxxxxx xxxxx, the amount xxxxxxxx xxx victim xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx accidents, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx xxxx xx directed to xxx insurers providing xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx isolated xxxxx, xx xxxx xx exceptional xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx provision xx financial xxxxxxx xx xxxxx xxxx xxx Ministry xx Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx confirmations xxxxxxxx xxx xxx respective xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. If the xxxxxxxxx fails xx xx xx, xxx Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx deliver any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even within x xxxxxxxxxxxxx xxxxxxxx, xxxx fact xxx xxxxxxx a xxxxxxxx xx xxxxxxxx any xxxxxxx xx xxx Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, however, xxxxxxxxx xxx xxxxxx of xxxxxxx xxxxxxxxxxx.

- Please xxxx in mind xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx amount xxxxxxxx xx compensation for xxxx (xxxx the xxxxxxxx, xxxxxxxx etc.) xx the xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx up xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx he/she xxx xxx received any xxxxxxxxxxxx. Xx so xxxxxxxxx by xxx xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx the state's xxxxx xx xxxxx xxx return xx xxx financial xxxxxxx xxxxxxxx after the xxxxx xx xxx xxxx-xxxx xxxx, provided xxxx x waiver xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of xxx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx to xxx xxxxxx.

Vážený pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, v ktorej xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. V xxxxxx rýchleho posúdenia Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx x žiadateľovi - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx xx zdraví, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx pobytu:

5. Xxxxxxxxxxxxxx adresa (x xxxxxxx, xx xx xxxx xx adresy xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) na xxxxxxx zákonného xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) xxxxx xx xxxxxxx dohody x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx osobu, xxxx xx doložiť xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx zastúpení) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X akom xxxxxx xxxx zomretá xxxxx x xôxxxxxx xxxxxxxxx činu x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx žijúca x spoločnej domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx xxxxxxxx kópia xxxxxxxx xxxxx x xxxxxxx, xxxxx dokladajú xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx mala xxxxxxxxx xx vyživovať (xx vzťahu rodič - xxxxx pôjde x rodný xxxx xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx povinnosti, xxx xxxxxxxx xxxxx xxxxxxxx xxxx sobášny xxxx x pod.)

IV. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx na peňažný xxxx; x xxxxx xxxxxxx láskavo oznámte xxxxx Xxxxx xxxx.

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

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

XX. Označte xxxxx činný x xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx konanie o xxxxxxxx čine. Xxxxxx xx xxxxxxx xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx činného v xxxxxxxx konaní, xxxxx xxxx predstavu o xxx, x akom xxxxxx xx xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx nárok xx xxxxxxx xxxxx od xxxxxxxľx xxxxx inej xxxxx, ktorá xxxxxxxxx xx xxxxx.

Xxxľx ustanovenia §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx xx môže xxxxxx xxxxx xx xxxxxxxx s xxxxxxxxxxxxx xx xx, xx xxxx xxxxxxx všetky xxxxxxx prostriedky xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx trestného činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx žiadateľ je xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 xxxxxx x. 209/1997 Zb., prípadne xxľxx xxôx spľňa xxxxx xxxxxxxxx, ak xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, manželom xxxxx dieťaťom osoby, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx xxxx?

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

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

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

Podľa xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Xx. sa xx xxxx považuje xxxxx xxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx, xx xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx xxxxx x xxx xxxx x xxxxxxxxxx xxxxx osoba, xxxxxx nebohý xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XXX. Xxxxxxx, xx sa xxxxxxxľ xxxx obeťou trestného xxxx x xxxx xx xxôxxxxxx xxxx xx zdraví.

IX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx bolesť podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa od xxxxxx, xxxxx xx xxxxxxxxx. Tento lekársky xxxxxxx bude obsahovať xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx a xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 bodov.

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

Xxxľx ustanovenia §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť xxxxx xxxxx poskytnúť peňažnú xxxxx vo výške xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na liečenie x ušlému xxxxxxx. Xx xx rozhodnete xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, nemusíte xx vyplňovať body XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s liečením xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x domácnosti či xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. xxx xxxxxxxxxx, xx tieto xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx náklady sa xxxxx xxxxxxx, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

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

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré potvrdzujú xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. zákona x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx dôchodku. X prípade, že x nejakého xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx pomery xxxxxxxľx, x xxxxxxx prípade xx xxxxx xxxxxxxx xxxxxxxxxx x nich xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx na xxxxxx, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným činom Xxx xxxxxxxx invalidný xôxxxxxx, uveďte a xxxxxxx xxxx xxxxx.

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

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

Xxxxxx xx vedomie, xx xx xxxľx ust. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx neskorších predpisov, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx dostal(a) ako xxxxxxx škody, a xx xx xx xxxxx poskytnutej xxxxxx. Xxxxxxx s tým xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja xxxxxxxx xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili a xxxxx xxxxxxx, xxxxx xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 písm. c) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x znení neskorších xxxxxxxxx.

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx po xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx xx xxxxxxx xx na xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx podaní žiadosti x predložení potrebných xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx dôvody, prečo xxxxx nemožno xxxxxxxx.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Nevyhnutnou, xxx xxxx postačujúcou xxxxxxxxxx xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx xxxxx, ktorá x dôsledku xxxxxxxxx xxxx xxxxxxx, ak xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx v xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, alebo xxxxx, ktorej xxxxxxx xxxxxxxxxx alebo xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx prekluzívnu (xxxxxxxx) xxxx 1 roka xxx xxx, xxx xx xxxx dozvedela x škode xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom už xxx je xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx sa xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx po uplynutí xxxxxxxxxx xxxxxx.

- Pomoc xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx na xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx na xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, ktoré xxxx x xxxxxx xxxxxxx xxxxx už xxxxxxx; pomoc xx xxxxxx xxxxx nesmie xxxxxxxxxx sumu 150 000.- Xx. Ak xxxx - xx xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx na xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx stanovenej týmto xxxxxxx xxx xxxxx xxxxxxxxx pomoc xxäx, x xx až xx maximálnej výšky 150&xxxx;000.- Xx; xxxxxx xx prihliadne xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx xxxx rodičom, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x zároveň x xxxx jeho xxxxx x xxx xxxx x domácnosti, xxxxx xxx zomretý xxxxxxxxxx, či xxx xxxxxxx poskytovať xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx presiahnuť xxxx 450 000.- Kč, x ak xx xxxxx obetí xxxx xxx xxx osoby, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx vozidiel, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx dopravných xxxôx žiadať xxxxxxx, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, na xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx ani xxxxxxxxx xxxxxx, táto skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať novú xxxxxxx.

- Upozorňujeme, že xx bude xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je xx xxxxxxx xxxxx xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx škody (xx xxxxxxxľx, poisťovne x xxx.) až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx xxxx, xx xx škodu xxxxxxxxxx. Na základe xxxxxxxx obete xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx štátu xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x výška xxxxxxx, ktorú xxxx xxxxxxx.