Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Applications xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support to Xxxxxxx xx Xxxxxxxx Xxxx pursuant xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx to the xxxxxxx xx xxxxxxxx xxxx and on xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx xxx with xxxxxxxx questions xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx xxx xxx xxxxx assessment xx xxxx xxxxxxxxxxx for xxx provision of xxxxxxxxx support xxxxxxxx xx Act xx. 209/1997. Thank xxx xxx xxxx cooperation; xx is highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx xx xxx xxxxxxxx data of xxx applicant - x.x. xxx xxxxxx xx the criminal xxx xxx has xxxxxxxx bodily xxxx, xx xxx xxxxxxxx xx a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal act:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Xxxxxx:

7. X-xxxx address:

8. Nationality:

II. Xx xxx xxxxxxxxx xx represented xx xxxxxxx xxxxxx ("representative") xx the basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx the xxxxx of a xxxxx xx attorney, xxxxxx xxxx xx xxx data xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx is xxxxxx the xxxxxxxxxxx xx behalf xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx represent the xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx representation) xx x copy xx xxx xxxxx xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx xxx xxxxxxxxx xx x survivor xx a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, please xxxx xx the xxxxxxxx xxxx xx the xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Nationality:

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

If xxx applicant xx x survivor of x xxxxxx who xxxx in xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x copy of xxx death certificate xxx xxx documents xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx support xxx xxxxxxxx (in xxx xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, such xxxxxxxxx include birth xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx to xxxxxxx xxx dependent; xx xxx xxxx xx married xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx xx xxxxx xxx xxxxx was xxxxxxxxx xxx, if xxx xxxxxx xxxxxxx xxxxx the xxxxxxxxxxxx xx xxx xxxxx xx a xxxxx xxxx, xxxxxx xxxx xxxxxxx the xxxx xxx the xxxxxx xx xxxxx the xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx of xxx medical report).

VI. Xxxxxx specify xxx xxxxxxxx xxxxxxx authority (x.x. police, xxxxxx xxxxxxxxxx'x office, xxxxx) xxxxx xxxx recently xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx reference xxxxxx xx xxx xxxx related xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx the abovementioned xxxxxxxx justice authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, copy xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the provisions xx §8 of Xxx no. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx depending on xxxxxxx xxx victim xxx xxxx xxx xx xxx legal xxxxxxxx to enforce x claim for xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx xxx xxxxx xxxxxx responsible xxx xxx xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx not xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx applicant is x survivor xx xx xxxxxxxxxx xxx xxx died in xxxxxxxxxxx xx the xxxxxxxxx crime.

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

2. Xxx you live xx x common xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx prior xx xxx commitment xx xxx xxxxx?

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

4. Xx xxx other xxxxxxx meet the xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 to 3? Please give xxxxx xxxxxx, if xxxxx xx xxx.

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Xxxxxxxxx xx xxx provisions xx §2, section 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx xx x xxxxxx who xxxx in consequence xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx x xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx child xx xxx deceased xxx xxxxx xxxx him xx her xx xxx same xxxxxxxxx xx if xxx xxxxxx xxx x xxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxxxx xxx required xx xxxxxxx xxx xxxxxx.

Xx xxx xxxxxxxxx xx xxx victim xx x crime xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx items XX - XXX.

Xxxxxx attach x point-based xxxxxxxxxx xx pain xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx be xxxxxxxx from xxx xxxxxxxxx responsible for xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xxx a point-based xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx that xxxx xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, section 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx will xx xxxxxxxx xxxxxx xxx xxxxx assessment of xxx pain xxxxxxxx xx at xxxxx 100 points.

The xxxxxx may obtain xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx medical treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx a of Xxx No. 209/1997 Xxxx.). xx you xxxxxx to xxxxx xxx x lump xxx xxxxxxx, xxxxx xx xx xxxx xx xxxx xx xxxxx XII - XxX.

This xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx such xxxxx have not xxxx xxxx xx xx insurance company. xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx evidence, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Please attach xxx xxxxxxxxx confirming xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is xx xxxxxxxx, these xxxxxxxxx xxxxx xxxxxxx a xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. of Xxx xx. 262/2006, xxx Xxxxx Labour Xxxx, xx xxxxxxx. lf xxx applicant is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be x xxxx xx xxx/xxx xxxx recent xxx xxxxxx. xx the xxxxxxxxx is a xxxxxxx person xxx xx xxxx xx xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a document xxxxxxxxxx xxx amount xx the retirement xxxxxxx. lf xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx situation xxxxxx be proven, xx xxxxxxxxxxx xxxxx xx affidavit may xx xxxxxxxx.

My xxxxxx xxxxxxxx has xxxx xxxxxxxx as x xxxxxx of xxx criminal act xx xxxxx X xxx x victim. X have xxx xxx xxxx compensated xxx the harm 1 have xxxxxxxx xx a result xx xxx xxxxxxxx xxx.

X xxxxxx affirm xxxx X xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx for xxx xxxx suffered xx x xxxxxx xx xxx criminal xxx xx xxx country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx the xxxxxxx xx criminal xxxx xxx on xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Xxxxxxx xxx xxxxxx received as xxxxxxxxxxxx for xxx xxxx suffered, xx xx the amount xx xxx financial xxxxxxx, within five xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx support. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx xxxxx the xxxxx'x claim xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx be xxxx xxxxxxxx by xx xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx information or xxxxxxxxxxx information for xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent xx xxxxxxx xxxxxxxx to §21, section 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx xx xxx xxxxxxxxxxx for xxx xxxxxxxxx of financial xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx of Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx a serial xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx xxxxxx xx x similar xxxxxxxxx xx per xxx xxxxxxxx details of xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx xx xxx application and xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, the Xxxxxxxx shall either xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx of the xxxxxxx why such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx xxxxxxxxxx x victim xx xxx Xxx Xx. 209/1997 Xxxx. only xx he/she xxx xxxxxxxx xxxxxx harm xx x xxxxxx xx the xxxxxxxxxx xx x xxxxx. X necessary xxx xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx (not xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx has xxxx xx consequence xx x xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx if xxx xxxxxxxx xx x xxxxxx, spouse or xxxxx xx the xxxxxxxx xxx the xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx xx the xxxx of his/her xxxxx or xx xxx deceased xxxxxxxxx xx was required xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxxxxxx xx criminal xxxx xxxxxxxxxx x xxxxxxxxxx xxxx xx 1 year xxxx xxx date on xxxxx xxx victim xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx. If xxxx xxxx does xxx xxxxxxxx xxxx xxx date xx xxx xxxxxxxxxx of xxx xxxxx, the xxxxxx xxxxx xxxxxxx xxxxxxxx xx the xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx of Justice xxxxxx meet xx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx received anytime xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Financial support xx xxxxxxx xxx xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x xxxxx xxx xx in xxx xxxx xx x xxxx sum xxxxxxxxx xx XXX 25,000 xx an xxxxxx xxxxx xx lost xxxxxx xx the xxxxx of medical xxxxxxxxx xx proved xx the victim, xxxxxxx xx any xxxxxx xxxxxxxxxx xxxx xx the xxxxxx xx xxxxxxxxxxxx xxx xxx harm xxxxxxxx. Xxx total xxxxxx xx xxxx support xxxx not xxxxxx XXX 150,000. If, xxxxx the provision xx xxxxxxx, xxx xxxxxx proves xxxx xxx harm xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx receive xxxxxxxxxx xxxxxxx up xx xxx amount xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx xxxx xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by the xxxxx); xx xxxx xxxx, any amounts xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- Xx individual xxx is a xxxxxxxx xx x xxxxxx who xxx xxxx as a xxxxxx xx xxx xxxxxxxxxx xx a xxxxx (x parent, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx death xx xxxxxxxxx by xx xxxxxxxx to be xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx as xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx xxxxxx xxxxx be reduced xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. does xxx replace xxx xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx liability xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx an xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial support xx filed with xxx Ministry xx Xxxxxxx.

- Xxxxxx bear xx mind xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. If the xxxxxxxxx xxxxx to xx xx, xxx Xxxxxxxx of Xxxxxxx xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx deadline, xxxx fact xxx xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx xxx Xxx No. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx of xxxxxxx xxxxxxxxxxx.

- Please xxxx in mind xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx xxxxxx received xx xxxxxxxxxxxx xxx xxxx (from xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx xxxxxx xx the support xxxxxxxx. This obligation xxxx xxx apply xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. If so xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, xxx Ministry xx Xxxxxxx xxx xxxxx the xxxxx'x xxxxx xx xxxxx xxx xxxxxx xx xxx xxxxxxxxx support xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx a xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx total xxxxxx xx xxx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx paid xx xxx xxxxxx.

Vážený pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx rýchleho posúdenia Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej činnosti xxxľx zákona č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám za xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx o žiadateľovi - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx pozostalej xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx trvalého xxxxxx:

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte xxxxx xxxxx xxxx (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, xxxxxxx, prosím, xx xxxxx x umretej xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. V xxxx xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx žijúca x xxxxxxxxx xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx po osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x žiadosti xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx vyživovala pozostalú xxxxx alebo mala xxxxxxxxx xx vyživovať (xx vzťahu xxxxx - xxxxx pôjde x rodný xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx povinnosti, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx na xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx účtu.

V. Xxxxxx dátum, xxxx xx xxxx dozvedela x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

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

XX. Označte xxxxx xxxxx v xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx konanie x xxxxxxxx čine. Xxxxxx xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného x xxxxxxxx xxxxxx, ktoré xxxx predstavu x xxx, x xxxx xxxxxx xx vec xxxxxxxx (xxxx. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x xxxxxxxx.

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

Xxxľx ustanovenia §8 xxxxxx x. 209/1997 (Xx)., peňažitá xxxxx sa xôxx xxxxxx xxxxx xx xxxxxxxx s xxxxxxxxxxxxx xx xx, či xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, ktorá zodpovedá xx xxxxx. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx žiadateľ xx xxxxxxxxxx po osobe, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 xxxxxx x. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, ak xx Vám tieto xxxxxxxxxxx xxxxx.

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

2. Xxxx ste x xxxxxx xxxxxxxxx xxxx xxxx vykonaním xxxxxxxxx xxxx x spoločnej xxxxxxxxxx?

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

4. Xxľxxxx další xxxxx xxxxxxxxxxx podmienky 1 xx 3? Uveďte xxx xxxxx, ak Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 odst. 2 xxxxxx x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx je xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx smrti x xxx xxxx v xxxxxxxxxx alebo xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx IX. xx XXX. Vyplňte, xx sa xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx x xxxx xx spôsobená xxxx xx xxxxxx.

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

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx spoločenského xxxxxxxxxx. Xxxxxxxxxxx, že xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona č. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 bodov.

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

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. a) zákona x. 209/1997 Zb. xx žiadosť xxxxx xxxxx poskytnúť xxxxxxx xxxxx xx výške xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx vo xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx na liečenie x xxxxxx zárobku. Xx xx rozhodnete xxxxxx o peňažnú xxxxx vo výške xxxxxxxxx xxxxxxx, xxxxxxxx xx vyplňovať body XXX. - XIV. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. xxx podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, inak xx xx ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx zreteľ.

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

X xxxxxxxx pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx žiadateľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx listinou xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx závažného xôxxxx nemožno doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx ich xxxxxxxľ poberá, xx xxxxxxx po xxxxxx xxxx na xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx poisťovne x výške xxxxxxxxxxxx xxxxx. X prípade, xx x xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali invalidný xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

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

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx spôsobenej xxxxxxxx xxxxx som xxxxxxxxxx(x) x xxxxxxx inom xxxxx ako x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx vedomie, že xx podľa xxx. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx x o xxxxx x x doplnení xxxxxxxxxx xxxxxxx, x xxxxx neskorších xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, x xx až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx po xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja sociálna xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx a xxxxx xxxxxxx, ktorú xxx dostal(a).

Beriem tiež xx vedomie, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx xxxxxx získania xxxxxxxxxxxx xxxxxx, sa xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx xxxxxxxxx po xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x udelí xxxxxxxx xxxxx. Potom bude xxxxxxxxxx xx xxxxxxx xx xx inom xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx mesiacov xx xxxxxx žiadosti x predložení xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx nemožno xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx činu xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx xxxxx bodového xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela, ak xxxx xxxxxxx, manželom xxxxx dieťaťom zomretého x xxxxxxx x xxxx jeho xxxxx x xxx žila x xxxxxxxxxx, alebo xxxxx, ktorej zomretý xxxxxxxxxx xxxxx xxx xxxxxxx poskytovať xxxxxx.

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

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx škoda na xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25 000.- Xx alebo xx xxxxx, ktorá predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z xxxxxx xxxxxxx xxxxx už xxxxxxx; xxxxx vo xxxxxx súčte nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Ak xxxx - xx tom, xxx xxx poskytli xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx žiadosť v xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx až xx xxxxxxxxxx xxxxx 150&xxxx;000.- Kč; pričom xx prihliadne xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, xxxxx xx xxxxxxxxxx xx obeti, xxxxx x dôsledku xxxxxxxxx činu xxxxxxx (xx xxxx rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx a zároveň x xxxx jeho xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, či bol xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx xxxxxxx xxxxx x paušálnej xxxx 150 000.- Kč; xxxxx vo svojom xxxxx nesmie xxxxxxxxxx xxxx 450 000.- Kč, x ak xx xxxxx xxxxx viac xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx xxxxxx obeti xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach dopravných xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Len x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx xx xxxxx xxxxxx ministerstvo spravodlivosti x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx xxxxxxx. Ak xxxxxx potvrdenia x xxxxxxx xxx xxxxxxxxx xxxxxx, táto xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx rokov xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx ako xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx do xxxxx poskytnutej xxxxxx. Xxxx povinnosť nemá, xx xx xxxxx xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti môže x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx xxxx vzdať xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx postup xxôxxxxxxx sociálna situácia xxxxx, celková xxxxx xxxxx, ktorú jej xxôxxxxxx, a výška xxxxxxx, xxxxx obeť xxxxxxx.