Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support xx Xxxxxxx xx Criminal Xxxx xxxxxxxx to Xxx Xx. 209/1997 Xxxx., on xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx to the xxxxxxx xx xxxxxxxx xxxx and xx xxxxxxxx xxxxxxx xxxxx xxxx, as amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx situation. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx xxx xxx xxxxx assessment xx xxxx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx xxxxxxx xxxxxxxx xx Act xx. 209/1997. Thank xxx xxx your cooperation; xx is xxxxxx xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in the xxxxxxxx xxxx of xxx applicant - x.x. xxx victim xx xxx xxxxxxxx xxx xxx has xxxxxxxx xxxxxx harm, xx the xxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

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

6. Phone Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx the basis xx xxxxxxxxx representation (xxx instance, x xxxxx xxxxx represented xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx x xxxxx of xxxxxxxx, xxxxxx xxxx in xxx data xx xxxx representative:

1. Surname:

2. Xxxxx name:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx behalf xx xxx applicant, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a copy xx xxx xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx applicant xx x xxxxxxxx xx x xxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, xxxxxx fill xx xxx personal xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxx of xxxxx:

5. Last permanent xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx applicant xx x survivor of x xxxxxx xxx xxxx in xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx attach x xxxx of xxx death certificate xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (in xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx or x xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx on which xxx xxxxx xxx xxxxxxxxx xxx, xx xxx victim learned xxxxx xxx consequences xx xxx crime xx x xxxxx xxxx, please xxxx xxxxxxx the xxxx xxx xxx xxxxxx xx which xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (e.g., xxx date xx xxx medical report).

VI. Xxxxxx specify xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx the reference xxxxxx of xxx xxxx related xx xxx respective proceedings.

If xxxxxxxxx, xxxxxx attach xxx latest xxxxxxxx xx xxx abovementioned xxxxxxxx xxxxxxx xxxxxxxxx xxxxx could xxxxxxxx xxx xxxxx xx xxx respective proceedings (x.x. xxxxxxxxxx xx xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the provisions xx §8 xx Xxx no. 209/1997, xxx amount of xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx depending on xxxxxxx the xxxxxx xxx xxxx xxx xx all xxxxx xxxxxxxx xx enforce x xxxxx for xxxxxxxxxxxx against xxx xxxxxxxx xx xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx if the xxxxxxxx xxx not xxxx identified.

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Fill xx xxxx VlIl xx xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx who xxx died xx xxxxxxxxxxx of xxx xxxxxxxxx xxxxx.

1. Xxx xxx a xxxxx, xxxxxx xx xxxxx xx xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxxxxxx?

2. Xxx xxx live xx x common xxxxxxxxx with the xxxxxxxx xxxxxx xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

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

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

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According xx the xxxxxxxxxx xx §2, section 2 of Xxx xx. 209/1997, a xxxxxx who xx x xxxxxxxx xx x victim xxx xxxx in consequence xx a xxxxxxxx xxx is xxxxxxxxxx xx be x xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx child xx xxx xxxxxxxx xxx xxxxx xxxx xxx xx her xx xxx same household xx xx the xxxxxx was x xxxxxxxxx of xxx xxxxxxxx or xxx xxxxxxxx was xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx xxx xxxxxxxxx xx the xxxxxx xx x crime xxx has xxxxxxxx xxxxxx harm, please xxxx xx xxxxx XX - XXX.

Xxxxxx xxxxxx x point-based xxxxxxxxxx xx xxxx and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx a point-based xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x xxxxxx position. Xxxxxx bear in xxxx that xxxx xxx point-based xxxxxxxxxx xx xxx pam xxxxxxxx xx xxxxxxxx xxx the xxxxxxxx xx Xxx xx. 209/1997. According to xxx provisions xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx of xxx xxxx xxxxxxxx xx at xxxxx 100 xxxxxx.

Xxx xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx of XXX 25,000 xx xx xxxxxx equal xx xxx proved xxxxx xx xxxxxxx treatment xxx xxxx income (§7, section 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). lf you xxxxxx to xxxxx xxx x lump xxx xxxxxxx, there xx xx need xx fill in xxxxx XII - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx home or xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., provided xxxx xxxxx xxxx not xxxx paid xx xx insurance company. xx xxxx xxxxxxxx xxx xxx xxxxxx xx documentary xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx not xxxx xxxx xxxx xxxxxxxxxxxxx.

Please attach xxx documents confirming xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is an xxxxxxxx, these xxxxxxxxx xxxxx include x xxxxxxxxx from his/her xxxxxxxx describing xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, the Xxxxx Labour Xxxx, xx amended. xx xxx applicant xx xxxx-xxxxxxxx, xxxx document xxxxx xx a xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. lf xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx xx xxxxx xxx/xxx impaired xxxxxx standing, please xxxxxx x xxxxxxxx xxxxxxxxxx the amount xx xxx xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x xxxxxx situation xxxxxx xx xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx may xx attached.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx xx which X xxx x xxxxxx. X xxxx not xxx xxxx compensated xxx the harm 1 have xxxxxxxx xx x result xx xxx criminal xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx lodged xxx xxxxx for xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx for xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 xx Act Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx financial xxxxxxx xxx the victims xx criminal xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx to xxxxxxxxx the Xxxxxxxx xx Xxxxxxx any xxxxxx received as xxxxxxxxxxxx xxx the xxxx suffered, up xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx from xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx xxx xxxx-xxxx period, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx waive xxx xxxxx'x claim xxx xxx return of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of xxxx xxxxxxxx and xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx information xxx xxx purposes xx xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, section 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx of xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx of xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Ministry xx Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx x serial xxxxxx. Subsequently, xxx Xxxxxxxx shall xxxxxxxx xx xxxxxxxxxxxxx with xxx xxxxxx xx x xxxxxxx authority xx per xxx xxxxxxxx xxxxxxx xx xxx xxxx. Within xxxxx xxxxxx xxxx xxx date of xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, the Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx of xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- Xxx applicant xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Act No. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx harm xx x result xx xxx xxxxxxxxxx xx x xxxxx. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx xxx amount xx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx weakening of xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx who xxx xxxx in consequence xx x xxxxx xxxxx xx considered xx xx x xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx xxx the xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx at the xxxx of his/her xxxxx or xx xxx deceased supported xx xxx xxxxxxxx xx support xxx xxxxxxxx.

- Act Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx stipulates a xxxxxxxxxx xxxx of 1 year xxxx xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx. Xx xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx of xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx shall xxxxxxx xxxxxxxx xx the xxxx on which xx/xxx learned xx xxx xxxxxxxxxxxx. The Xxxxxxxx of Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xxxxxxxx xxxxxxx xxxxx the xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x xxxxx xxx xx xx xxx xxxx xx x xxxx xxx xxxxxxxxx xx CZK 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx or the xxxxx of xxxxxxx xxxxxxxxx as proved xx xxx xxxxxx, xxxxxxx by any xxxxxx xxxxxxxxxx xxxx xx the xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx incurred. Xxx xxxxx amount xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx support, xxx xxxxxx proves xxxx xxx xxxx xxxxxxxx xxxxxxx xxx amount xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx for xx within the xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx from xxx xxxx xx which xxx victim xxxxxxx xx xxx xxxx xxxxxx xx the xxxxx); xx xxxx xxxx, any amounts xxxxxxx paid xxxx xx xxxxx xxxx xxxxxxx.

- An xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx as x xxxxxx xx the xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx child xx xxx deceased xxxxxx xx a xxxxxx household with xxx deceased xx xxx xxxx of xxx/xxx xxxxx or xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx a xxxx xxx amounting xx XXX 150,000. Xxx xxxxx amount xxxxxxxx as xxxxxxxxx xxxxxxx shall not xxxxxx XXX 450,000; xxxxxx the xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per victim xxxxx be xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx the xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx motor xxxxxxxx xxxxxxx xx xxxxxxxxxx liability insurance. Xx matters related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx xx xxx xxxxxxxx providing xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx view xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx support xx filed with xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx available documents xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx applicant fail xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx a decision xx xxxxxxxx any xxxxxxx as xxx Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, however, xxxxxxxxx xxx filing of xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx be xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, insurers xxx.) xx the xxxxxxx xx xxx Ministry xx Xxxxxxx xx xx xxx amount xx the xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx not xxxxx xx xx/xxx xxx xxx received xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Justice may xxxxx the xxxxx'x xxxxx to xxxxx xxx xxxxxx xx xxx xxxxxxxxx support xxxxxxxx after the xxxxx of xxx xxxx-xxxx xxxx, provided xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, the total xxxxxx of the xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx xx xxx victim.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx v xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Vás xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx rýchleho posúdenia Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, ktorá x dôsledku xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx rodičom) xxxxx xx xxxxxxx xxxxxx x plnej xxxx, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Preto x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (pri xxxxxxxx xxxxxxxxx) alebo xxxxx xxxxxxx listu (x prípade xxxxxxxxx xxxxxxxxxx) alebo xxx xxxxxxx xxxxxxx.

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

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola xxxxxxx xxxxx x dôsledku xxxxxxxxx činu x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu xxxxx - dieťa pôjde x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx povinnosti, xxx xxxxxxxx takou xxxxxxxx xxxx sobášny xxxx x xxx.)

XX. Xxxxxx, či žiadate xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx pošty alebo xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x xx xx xxxx x xxxxx xxx spôsobenej dozvedela xx xxxxôx, xxxxxx xxxx x xxx (xxxxxxxxx z xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne zastupitelstvo, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx o xxxxxxxx xxxx. Xxxxxx xx spisovú xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx posledné rozhodnutie xxxxxx činného x xxxxxxxx xxxxxx, ktoré xxxx predstavu o xxx, x akom xxxxxx sa xxx xxxxxxxx (napr. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx nárok xx xxxxxxx škody xx xxxxxxxľx alebo xxxx xxxxx, ktorá xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Xx)., xxxxxxxx xxxxx sa môže xxxxxx alebo xx xxxxxxxx x prihliadnutím xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx na xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx škodu. Tento xxx xxxxxxxxxxx, ak xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx XXXX. Vyplňte, xx xxxxxxxľ xx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx ste xxxxxxx xxxxxx, xxxxx xxľxx podmienky uvedené x §2 xxxx. 2 xxxxxx č. 209/1997 Zb., xxxxxxxx xxľxx xxôx spľňa xxxxx podmienky, ak xx Vám xxxxx xxxxxxxxxxx známe.

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

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

3. Xxxxxxxxxxx Xxx xxxx xxxxxxxxx činu xxxxxx, xx xxxx x xxxx xxxxxxx?

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

Podľa xxxxxxxxxxx §2 odst. 2 zákona x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx xxxxxxxxx činu xxxxxxx, xx xx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx xxxxx osoba, xxxxxx nebohý xxxxxxxxxx xxxxx xxx povinný xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Vyplňte, xx xx xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx x bola xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, xxxx sa xxxxxxxx liečenie, respektíve xxxx sa xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové ohodnotenie xx bolesť podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa xx xxxxxx, xxxxx ho xxxxxxxxx. Tento lekársky xxxxxxx xxxx xxxxxxxxx xxxxxx hodnotenie vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx xxxxx, xx bodové ohodnotenie xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

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

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. a) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx poskytnúť peňažnú xxxxx vo výške xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx zodpovedajúcej preukázaným xxxxxxxx xx xxxxxxxx x xxxxxx zárobku. Xx xx rozhodnete xxxxxx x xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxxxxx, nemusíte xx vyplňovať body XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Náklady xxxxxxx x liečením xxxxxx:

Xxx x xxxxxxx xx lieky, zdravotnícke xxxôxxx, náklady xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x xxxxxxxxxx či xxxxxxxxxx, zvýšené náklady xx xxxxxxx, a xxx. pod xxxxxxxxxx, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx náklady xx xxxxx doložiť, xxxx xx ne ministerstvo xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx pomery žiadateľa xxxx x po xxxxxx ujmy na xxxxxx xxôxxxxxxx trestným xxxxx.

X žiadosti xxxxxxxx xxxxxxx, ktoré xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx o potvrdenie xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x nasl. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx predpisov. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx situáciu, xxxx potvrdenie x xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o nich xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx nemocenských dávok (xxxxxxxxxxx xôxxxxxx) a xxxx, xxxxxx ich xxxxxxxľ xxxxxx, xx xxxxxxx xx vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx poisťovne x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx xx zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx výšku.

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx činom, ktorého xxx bol(a) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx xx odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom xxxx xxxxx xxx v Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx xxxxxxx, xx xx xxxľx xxx. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx povinnosť xx xxxxxxx rokov xxx xxx, keď xx xxxxxxxx xxxxx, odviesť xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx dostal(a) xxx xxxxxxx xxxxx, x xx až do xxxxx poskytnutej xxxxxx. Xxxxxxx s tým xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, xxx xx x mene štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx xxxxxxxx xxxxxxxx bude xxxx xxxxxx odôvodňovať, xxxxxxx xxxxx škody, ktorú xx xxôxxxxxx a xxxxx náhrady, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx jeho zatajením xx xxxxxx získania xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 odst. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Potom xxxx xxxxxxxxxx na xxxxxxx xx xx inom xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx xxxxxxxx xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx mu x xôxxxxxx trestného xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx výška xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx sa xxxxxxxx xx xxxxx pozostalá xx obeti, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, xx xxxx xxxxxxx, manželom xxxxx dieťaťom xxxxxxxxx x xxxxxxx v xxxx xxxx smrti x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx dozvedela x škode xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx je xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx, ktoré xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Pomoc xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx na xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25&xxxx;000.- Xx alebo vo xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x liečením, xxxxxxx x xxxxx xxxxxxxx čiastok, ktoré xxxx x xxxxxx xxxxxxx škody xx xxxxxxx; pomoc vo xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150 000.- Xx. Xx obeť - po xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx jej xxxxxxxxx xxxxx je vyššia xxx tá, ktorá xxxx podkladom na xxxxxxxxxxx xxxxxx, na xxx žiadosť x xxxxxx stanovenej xxxxx xxxxxxx jej xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx na xxxxxxx, ktoré už xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx obeti, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx bola xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx a xxxxxxx x xxxx jeho xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx bol xxxxxxx poskytovať výživu), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx nesmie presiahnuť xxxx 450&xxxx;000.- Xx, x xx xx xxxxx xxxxx viac xxx tri xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx obeti xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx vozidiel, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx ojedinelých xxxxxxxxx x prihliadnutím xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx doklady x potvrdenia, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx xxxxxxxxx xxxxxx, táto xxxxxxxxxx xôxx xxx dôvodom xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je xx xxxxxxx xxxxx xxx xxx poskytnutia xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx spravodlivosti sumy, xxxxx dostal xxx xxxxxxx škody (xx xxxxxxxľx, poisťovne a xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx môže x xxxx štátu xx xxxxxxxx stanovenej xäxxxxxxx xxxx vzdať xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, xxxxxxx xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.