Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx to Xxx No. 209/1997 Xxxx., on xxx xxxxxxxxx xx fulancial xxxxxxx xx the xxxxxxx of criminal xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx questions xx xxxx current xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx questionnaire xx xxxxxxxx xxx the xxxxx assessment xx xxxx application xxx xxx provision xx xxxxxxxxx xxxxxxx xxxxxxxx xx Act xx. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

_____________________________________________________________________________________________

X. Xxxxxx legibly xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. the xxxxxx xx the xxxxxxxx xxx xxx has xxxxxxxx xxxxxx harm, xx xxx survivor xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx statutory representation (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx parent) xx xx xxx xxxxx of x xxxxx of xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx representative:

1. Surname:

2. Xxxxx xxxx:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, please xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx x xxxxx xx attorney (xxx xxxxxxxxxxx representation) xx x xxxx xx xxx birth xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or any xxxxx xxxxxxxxxx document.

III. Xx the xxxxxxxxx xx x xxxxxxxx xx x person xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxxx criminal xxx, xxxxxx fill xx the xxxxxxxx xxxx of xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxx of xxxxx:

5. Last permanent xxxxxxx:

6. Nationality:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx the applicant (x.x. father, xxxxxxxx, xx individual living xx xxxxxx household)

If xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x xxxx of xxx xxxxx certificate xxx any xxxxxxxxx xxxxxxx xxxx the xxxxxxxx xxxxxxxxx or xxx xx xxxxxxxxxx xx xxxxxxx the xxxxxxxx (xx the xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx or a xxxxx xxxxxxxx on xxx xxxxxxxxxx to xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx the xxxxx xx x later xxxx, xxxxxx also xxxxxxx xxx date xxx the xxxxxx xx xxxxx xxx xxxxxx xxxxxxx of xxxx consequences (x.x., xxx xxxx xx xxx medical xxxxxx).

XX. Xxxxxx specify xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx xxxx recently xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx the xxxxxxxxx xxxxxx xx xxx xxxx xxxxxxx xx xxx respective xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx latest xxxxxxxx xx xxx abovementioned xxxxxxxx xxxxxxx authority xxxxx could indicate xxx stage of xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx made use xx all legal xxxxxxxx xx xxxxxxx x claim for xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx not xxxx xx xxxx xxxx if xxx xxxxxxxx has xxx xxxx identified.

______________________________________________________________________________________________

Fill xx xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx of the xxxxxxxxx crime.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx xx the xxxxxx who xxxx xx consequence xx xxx xxxxxxxx xxxxxxx?

2. Xxx you live xx a xxxxxx xxxxxxxxx xxxx the xxxxxxxx xxxxxx xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

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

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

______________________________________________________________________________________________

Xxxxxxxxx xx xxx provisions xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, a xxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx a criminal xxx xx xxxxxxxxxx xx be x xxxxxx xx xx xx xxx is x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx in xxx xxxx household xx xx xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

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

Please attach x point-based assessment xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx xx xxxxxxxx from the xxxxxxxxx responsible xxx xxx xxxxxx'x treatment. Xxxx xxxxxxx report xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffered xxx a xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx bear xx xxxx that only xxx point-based xxxxxxxxxx xx the pam xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According to xxx provisions of §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx financial xxxxxxx xxxx be xxxxxxxx unless the xxxxx assessment xx xxx xxxx suffered xx at xxxxx 100 points.

Xxx xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx xxx xxxxxx xx XXX 25,000 or xx xxxxxx xxxxx to xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx lost xxxxxx (§7, section 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). lf you xxxxxx xx apply xxx a xxxx xxx payment, xxxxx xx xx xxxx xx fill in xxxxx XXX - XxX.

This xxxxxxxx xxx expenses xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx out xx xxx home xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx such xxxxx have not xxxx paid xx xx insurance xxxxxxx. xx xxxx xxxxxxxx xxx xxx proved xx xxxxxxxxxxx evidence, xxx Ministry xx Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx documents xxxxxxxxxx xxxx xxxxx xx xxx application.

If the xxxxxxxxx xx xx xxxxxxxx, these documents xxxxx include a xxxxxxxxx xxxx xxx/xxx xxxxxxxx describing xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, the Xxxxx Xxxxxx Xxxx, xx xxxxxxx. lf xxx xxxxxxxxx is xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx xx x xxxxxxx person xxx xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the xxxxxx xx the xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be proven, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx attached.

Xx xxxxxx standing has xxxx xxxxxxxx as x xxxxxx of xxx xxxxxxxx xxx xx xxxxx X xxx x xxxxxx. X xxxx not xxx been xxxxxxxxxxx xxx xxx harm 1 xxxx suffered xx x xxxxxx xx xxx xxxxxxxx xxx.

X hereby xxxxxx xxxx I have xxx xxxxxx xxx xxxxx for financial xxxxxxx or any xxxxxxx xxxxx for xxxxxxxxxxxx for the xxxx suffered xx x result xx xxx criminal act xx any xxxxxxx xxxxx xxxx xxx Xxxxx Republic.

I xxxxxxxxxxx xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx on amending xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Justice any xxxxxx received xx xxxxxxxxxxxx for xxx xxxx suffered, up xx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx, within xxxx xxxxx from xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx acknowledge xxxx, xxxxx the xxxxx xx the xxxx-xxxx period, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx such x xxxxxx xx well xxxxxxxx by my xxxxxx standing, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx information or xxxxxxxxxxx xxxxxxxxxxx xxx xxx purposes xx xxxxxxxxxxxxx gaining xxxxxxxx xxx represent an xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx c) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

-----------------------------------------------------------------

Xxxxxxxxx of xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx of xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Ministry xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx with xxx police xx x xxxxxxx authority xx per the xxxxxxxx details of xxx case. Within xxxxx months xxxx xxx xxxx xx xxx xxxxxxx of xxx xxxxxxxxxxx xxx xxxxxxxxxx xx the xxxxxxxxx xxxxxxxxx, the Xxxxxxxx shall xxxxxx xxxxxxx xxx support xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- The applicant xxxxx xx xxxxxxxxxx x victim as xxx Xxx Xx. 209/1997 Coll. only xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx commitment xx x crime. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx support xxxxx xx xxx xxxxxx xx the point-based xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx weakening of xxxxxx xxxxxxxx), xxxxx xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx xx xxxxxxxxxx xx xx a xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxx xxx xxxxxxxx shared x xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx support xxx xxxxxxxx.

- Xxx No. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx to xxxxxxx of xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx crime. Xx xxxx xxxx does xxx xxxxxxxx xxxx xxx date xx xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx xx the xxxx xx xxxxx xx/xxx learned xx xxx consequences. Xxx Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx the xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Financial support xx xxxxxxx for xx x xxxxxx xxx has xxxxxxxx xxxxxx xxxx xx x xxxxxx of xxx xxxxxxxxxx of x xxxxx xxx xx in the xxxx xx a xxxx xxx xxxxxxxxx xx CZK 25,000 xx xx xxxxxx xxxxx xx lost xxxxxx or xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx xx any xxxxxx previously xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx incurred. Xxx total xxxxxx xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx the xxxxxxxxxxxxxx period of xxxx (x.x., 1 xxxx from the xxxx xx xxxxx xxx xxxxxx learned xx the xxxx xxxxxx xx the xxxxx); xx xxxx xxxx, xxx amounts xxxxxxx paid will xx taken into xxxxxxx.

- Xx xxxxxxxxxx xxx xx x xxxxxxxx of x xxxxxx xxx has xxxx as a xxxxxx xx xxx xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx deceased at xxx xxxx xx xxx/xxx xxxxx xx xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx by the xxxxxxxx) xxxxx be xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx amount xxxxxxxx as xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx xxx number xx xxxxxxx exceed xxxxx, the amount xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. does xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx thus xx directed to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx exceptional xxxxxxxxxxxxx, xxx xx application xxx xxx xxxxxxxxx xx financial xxxxxxx xx xxxxx with xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx xxxx xx mind xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx the xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx the xxxxxxxxxxx. Xx the xxxxxxxxx fails xx xx xx, xxx Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx deliver any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx per Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, xxxxxxxxx xxx filing of xxxxxxx xxxxxxxxxxx.

- Please xxxx in xxxx xxxx xxx xxxxxxxxx xxxxx xx obliged xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx the xxxxxxxx, xxxxxxxx xxx.) xx the account xx xxx Xxxxxxxx xx Justice xx xx xxx amount xx xxx xxxxxxx xxxxxxxx. Xxxx obligation xxxx not xxxxx xx xx/xxx xxx xxx xxxxxxxx any xxxxxxxxxxxx. Xx so xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Xxxxxxx may xxxxx xxx xxxxx'x xxxxx to xxxxx xxx return xx xxx xxxxxxxxx support xxxxxxxx after xxx xxxxx xx the xxxx-xxxx xxxx, provided xxxx a xxxxxx xx justified xx xxx xxxxxx'x social xxxxxxxx, xxx total xxxxxx xx the xxxx suffered xxx xxx amount xx xxxxxxxxxxxx xxxx xx xxx victim.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, v ktorej xx nachádzate, xxx xxxxxx Vás obťažovať xxxxxxxxxxxx otázkami. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx zákona č. 209/1997 Zb., xx však xxxxxxxxx xxxxx dotazníku nevyhnutné. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

______________________________________________________________________________________________

X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx adresa (v xxxxxxx, xx sa xxxx od adresy xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx inú xxxxx, xxxx sa doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (pri xxxxxxxx zastúpení) xxxxx xxxxx rodného xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Xx xxxxxxxľ alebo osoba xxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, xxxxxxx, prosím, xx xxxxx o xxxxxxx xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné bydlisko:

7. Xxxxxxxxxx:

8. X akom xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, osoba xxxxxx x spoločnej domácnosti):

Ak xx žiadateľ osobou xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x žiadosti sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx pozostalú xxxxx alebo mala xxxxxxxxx ju vyživovať (xx xxxxxx xxxxx - dieťa xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x vyživovacej xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx bude xxxxxxx xxxx a pod.)

IV. Xxxxxx, xx žiadate xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo oznámte xxxxx Xxxxx účtu.

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

Uveďte xxxxx xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x xxxxx xxx spôsobenej xxxxxxxxx xx neskôr, uveďte xxxx a ako (xxxxxxxxx x xxxxxxxxx xxxxxx - dátum xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx xxxxxx (policajný xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx konanie x xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného x xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx o xxx, v xxxx xxxxxx sa xxx xxxxxxxx (xxxx. uznesenie x odložení xxxxxxxxx xxxxxxxx, opis obžaloby, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

VII. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx na xxxxxxx xxxxx od xxxxxxxľx xxxxx inej xxxxx, ktorá zodpovedá xx xxxxx.

Xxxľx ustanovenia §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

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

XXXX. Xxxxxx, či xxx xxxxxxx osobou, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona č. 209/1997 Xx., prípadne xxľxx osôb xxľxx xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

1. Boli xxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx v xôxxxxxx xxxxxxxxx xxxx?

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

3. Poskytovala Xxx xxxx xxxxxxxxx xxxx xxxxxx, xx bola x tomu xxxxxxx?

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

Podľa xxxxxxxxxxx §2 xxxx. 2 zákona x. 209/1997 Zb. sa xx xxxx xxxxxxxx xxxxx pozostalá xx xxxxx, xxxxx v xôxxxxxx trestného xxxx xxxxxxx, xx xx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

______________________________________________________________________________________________

Xxxx IX. xx XIV. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx trestného xxxx x xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, xxxx sa xxxxxxxx liečenie, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx bolesť xxxx:

X xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, xxxxx ho xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx hodnotenie xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Zb. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx bodové ohodnotenie xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 bodov.

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

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx vo výške xxxxxxxxx sumy 25 000.- Xx, alebo xx xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx body XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx o xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, x xxx. xxx podmienkou, xx tieto xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx xx ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx ujmy xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ xx x zamestnaneckom pomere, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx xxxxxxxľ poberá xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie x xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx závažného xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx xxxxx nahradiť xxxxxxxxxx x xxxx xxxxxxx vyhlásením.

XIV. Xxxxxx xxxxx nemocenských xxxxx (xxxxxxxxxxx dôchodku) a xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx na zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx xxxx výšku.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Škodu, xxxxx mi xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, že xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx v Xxxxxx (Slovenskej) republike.

Beriem xx vedomie, xx xx podľa ust. §12 zákona x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx x x xxxxx x x doplnení xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Ministerstva xxxxxxxxxxxxxx čiastky, ktoré xxx xxxxxx(x) ako xxxxxxx xxxxx, x xx xx do xxxxx poskytnutej xxxxxx. Xxxxxxx x tým xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx práva na xxxxxxxx poskytnutej xxxxxx, xx moja xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx škody, ktorú xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného údaja xx jeho xxxxxxxxx xx účelom získania xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 písm. x) xxxxxx č. 200/1990 Xx., o xxxxxxxxxxxx, x znení xxxxxxxxxx xxxxxxxxx.

------------------------------------------

xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Potom xxxx xxxxxxxxxx xx polícii xx na xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx poskynúť.

- X xxxxxx zákona č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Za xxxx sa považuje xx xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx trestného xxxx zomrela, ak xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x zároveň x xxxx xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 xxxx xxx dňa, keď xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje okamžik, xxxx xx xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx škoda xx xxxxxx, poskytne v xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx xx xxxxx, ktorá xxxxxxxxxxx xxxxxxxxxx stratu na xxxxxxx, preukázané náklady xxxxxxx s xxxxxxxx, xxxxxxx x súčet xxxxxxxx xxxxxxx, ktoré xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx súčte nesmie xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - po xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx pomoci, na xxx xxxxxxx v xxxxxx stanovenej xxxxx xxxxxxx jej možno xxxxxxxxx pomoc xxäx, x xx xx xx maximálnej výšky 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx xx xxxxxxx, ktoré xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela (xx bola xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x zároveň x čase xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxx zomretý xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne xxxxxxx xxxxx v paušálnej xxxx 150&xxxx;000.- Kč; xxxxx xx svojom xxxxx nesmie presiahnuť xxxx 450&xxxx;000.- Xx, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie zodpovednosti. Xxxxx je xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx plnenia. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx nevyhnutné xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, xx xxxxx odkazujeme xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx xxxxxxxxx xxxxxx, táto xxxxxxxxxx xôxx byť dôvodom xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx novú xxxxxxx.

- Upozorňujeme, že xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx rokov xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal ako xxxxxxx škody (od xxxxxxxľx, xxxxxxxxx a xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx povinnosť xxxx, xx xx škodu xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, celková výška xxxxx, ktorú xxx xxôxxxxxx, x výška xxxxxxx, ktorú xxxx xxxxxxx.