Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Assessment xx Xxxxxxxxxxxx for xxx Provision xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx and xx xxxxxxxx xxxxxxx xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx the xxxxx xxxxxxxxxx of xxxx application xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx you xxx your xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx in xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx xxx xxxxxxxx xxx xxx has xxxxxxxx xxxxxx harm, xx xxx xxxxxxxx xx x person xxx has died xx xxxxxxxxxxx xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given name:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx person ("xxxxxxxxxxxxxx") xx the basis xx xxxxxxxxx representation (xxx instance, a xxxxx xxxxx represented xx xxx/xxx parent) xx xx xxx xxxxx xx x xxxxx xx attorney, xxxxxx fill xx xxx data xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx the xxxxxxxxx - x xxxx xx x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx any xxxxx equivalent document.

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

1. Xxxxxxx:

2. Given xxxx:

3. Date xx xxxxx:

4. Xxxx of xxxxx:

5. Last permanent xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx applicant xx x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx any documents xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx an obligation xx xxxxxxx the xxxxxxxx (xx xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx a xxxxx xxxxxxxx on xxx obligation to 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 victim learned xxxxx the consequences xx xxx xxxxx xx a xxxxx xxxx, please xxxx xxxxxxx the date xxx xxx manner xx which xxx xxxxxx learned of xxxx consequences (x.x., xxx xxxx xx xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx the xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x office, xxxxx) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx the xxxxxxxxx xxxxxx of the xxxx related xx xxx respective xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx attach xxx latest decision xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx xxxxx indicate xxx xxxxx xx xxx xxxxxxxxxx proceedings (x.x. resolution xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx prosecution, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx xxxxxx of xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx xxxxxxxxx xx xxxxxxx xxx victim xxx xxxx use xx all xxxxx xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx against xxx xxxxxxxx or any xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Do xxx xxxx xx this xxxx xx xxx xxxxxxxx has not xxxx xxxxxxxxxx.

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Xxxx xx xxxx VlIl xx xxx xxxxxxxxx xx x xxxxxxxx xx xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx of xxx xxxxxx who xxxx xx consequence of xxx xxxxxxxx offence?

2. Xxx xxx xxxx xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xxxxxx prior xx xxx xxxxxxxxxx xx xxx xxxxx?

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

4. Xx xxx xxxxx xxxxxxx xxxx 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, a xxxxxx xxx xx x survivor xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx x criminal xxx xx considered xx be a xxxxxx if he xx she xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx xxxx him xx xxx in xxx xxxx xxxxxxxxx xx if xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

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

Xxxxxx attach x point-based xxxxxxxxxx xx xxxx and xxxxxxxxx pursuant to Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx should be xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx victim's xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx a xxxxx-xxxxx assessment xx xxx pam xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x social xxxxxxxx. Xxxxxx bear in xxxx xxxx xxxx xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx will xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain xxxxxxxx xx xx least 100 xxxxxx.

Xxx xxxxxx xxx obtain xxxx xxx financial xxxxxxx in xxx xxxxxx xx CZK 25,000 xx an xxxxxx equal xx xxx proved xxxxx xx medical xxxxxxxxx xxx lost xxxxxx (§7, section 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx xx xxxxx xxx x xxxx xxx payment, xxxxx xx xx xxxx xx xxxx in xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses for xxxxxxxxxx, sanitary equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx out xx xxx home or xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx have xxx xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx them xxxx xxxxxxxxxxxxx.

Xxxxxx attach xxx xxxxxxxxx confirming xxxx facts xx xxx application.

If xxx xxxxxxxxx xx xx xxxxxxxx, these xxxxxxxxx xxxxx include a xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx according xx §351 xx. xxx. of Act xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx xx his/her xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx xx x xxxxxxx xxxxxx who xx xxxx to xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the xxxxxx xx the xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x income situation xxxxxx xx proven, xx exceptional xxxxx xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x result xx xxx xxxxxxxx act xx xxxxx X xxx a xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx xxx xxxx 1 have xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx lodged xxx xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx for xxx xxxx suffered xx x xxxxxx xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx than xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Xxxxxxx xxx xxxxxx received as xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx support. X also xxxxxxxxxxx xxxx, after xxx xxxxx xx xxx xxxx-xxxx xxxxxx, X xxx xxxx an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Justice xx xxxxx xxx xxxxx'x xxxxx for xxx return xx xxx provided xxxxxxx, xxxxxx xxxx a xxxxxx xx xxxx xxxxxxxx xx my xxxxxx xxxxxxxx, xxx xxxxx extent xx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx or xxxxxxxxxx information or xxxxxxxxxxx xxxxxxxxxxx for xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx c) xx Xxx xx. 200/1990 Xxxx., xx offences xx amended.

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Signature xx xxx xxxxxxxxx xx xxx/xxx representative

- Upon xxxxxxx xx xxx xxxxxxxxxxx for the xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx to Xxx No. 209/1997, xxx Xxxxxxxx of Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx shall initiate xx xxxxxxxxxxxxx with xxx xxxxxx xx x xxxxxxx authority xx per the xxxxxxxx xxxxxxx xx xxx xxxx. Within xxxxx xxxxxx from xxx xxxx xx xxx receipt xx xxx application and xxxxxxxxxx xx xxx xxxxxxxxx documents, xxx Xxxxxxxx xxxxx either xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx of xxx xxxxxxx why such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx considered x victim xx xxx Xxx Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx bodily xxxx xx a xxxxxx xx xxx xxxxxxxxxx xx a xxxxx. X xxxxxxxxx xxx xxx the ohly xxxxxxxxx xxx the xxxxxx'x receipt xx xxxxxxxx support xxxxx xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx be xxxxxxxxxx xx be x xxxxxx xx xxx xxxxxxxx is x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx the xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx at the xxxx of his/her xxxxx xx if xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx No. 209/1997 Coll. xx xxx provision of xxxxxxxxx support xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx xxxx xx xxxxx the xxxxxx xxxxxxx xx xxx xxxx caused xx xxx xxxxx. Xx xxxx xxxx does xxx coincide with xxx date xx xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. The Xxxxxxxx of Xxxxxxx xxxxxx xxxx an xxxxxxxxxxx for the xxxxxxxxx of financial xxxxxxx received xxxxxxx xxxxx the xxxxx xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx applied xxx xx a xxxxxx xxx has xxxxxxxx xxxxxx harm xx x result xx xxx commitment xx x xxxxx xxx xx xx the xxxx of a xxxx xxx amounting xx CZK 25,000 xx xx xxxxxx xxxxx to xxxx xxxxxx xx xxx xxxxx xx medical xxxxxxxxx as proved xx xxx xxxxxx, xxxxxxx by xxx xxxxxx xxxxxxxxxx paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the provision xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx suffered xxxxxxx the amount xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx up xx xxx xxxxxx xx XXX 150,000 if xx/xxx applies xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx of xxxx (x.x., 1 xxxx from the xxxx xx which xxx victim xxxxxxx xx xxx xxxx xxxxxx xx the xxxxx); in such xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx taken into xxxxxxx.

- Xx xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (x parent, xxxxxx or xxxxx xx the xxxxxxxx xxxxxx xx x xxxxxx household xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx death xx xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx by the xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx victims xxxxxx xxxxx, the amount xxxxxxxx xxx xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. does xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of motor xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should thus xx xxxxxxxx to xxx insurers xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx xxxxxxx xx filed with xxx Xxxxxxxx xx Xxxxxxx.

- Please xxxx xx mind that xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx must xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx fails xx xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx process xxx application. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx any xxxx documents and xxxxxxxxxxxxx even within x supplementary deadline, xxxx fact xxx xxxxxxx a xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx in mind xxxx the applicant xxxxx xx obliged xx return any xxxxxxxxx amount xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx the xxxxxxxx, insurers xxx.) xx xxx xxxxxxx xx xxx Ministry xx Xxxxxxx up xx the xxxxxx xx xxx support xxxxxxxx. Xxxx xxxxxxxxxx xxxx not xxxxx xx he/she has xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx the xxxxx'x xxxxx xx xxxxx xxx return xx xxx xxxxxxxxx xxxxxxx xxxxxxxx after the xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx a xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of the xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx to xxx victim.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, v xxxxxx xx nachádzate, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx xxxxxxxxx iná xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx základe dohody x xxxxx xxxx, xxxxxxx údaje x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (xxx xxxxxxxx zastúpení) alebo xxxxx rodného xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ alebo xxxxx xxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx x umretej xxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. V akom xxxxxx bola zomretá xxxxx v xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x spoločnej domácnosti):

Ak xx žiadateľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx činu zomrela, x žiadosti xx xxxx priložiť xxxxx xxxxxxxx xxxxx a xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, že umretá xxxxx vyživovala pozostalú xxxxx alebo mala xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - xxxxx pôjde x rodný xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx sobášny xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx xxxxxxx xxxx; v takom xxxxxxx xxxxxxx oznámte xxxxx Vášho xxxx.

X. Xxxxxx xxxxx, xxxx xx obeť dozvedela x xxxxx spôsobenej xxxxxxxx xxxxx.

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

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx konaní (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie x xxxxxxxx čine. Uveďte xx xxxxxxx značku, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx v xxxxxxxx xxxxxx, ktoré xxxx predstavu o xxx, v xxxx xxxxxx xx vec xxxxxxxx (xxxx. uznesenie x odložení trestného xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx ho x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx xxxxx na xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Xx)., xxxxxxxx xxxxx xx môže xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, či xxxx využila xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx na xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx škodu. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx ste xxxxxxx osobou, xxxxx xxľxx podmienky uvedené x §2 odst. 2 zákona č. 209/1997 Xx., xxxxxxxx xxľxx xxôx spľňa xxxxx podmienky, xx xx Vám tieto xxxxxxxxxxx známe.

1. Xxxx xxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx trestného činu?

2. Xxxx ste s xxxxxx xxxxxxxxx činu xxxx vykonaním xxxxxxxxx xxxx v xxxxxxxxx xxxxxxxxxx?

3. Poskytovala Xxx xxxx trestného xxxx xxxxxx, xx xxxx x xxxx povinná?

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

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx je xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx xxxxx s xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx IX. xx XXX. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx trestného xxxx x bola xx spôsobená xxxx xx xxxxxx.

XX. Xxxxxx xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx bodového xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx xx musí xxxxxxxx bodové xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, xxxxx ho xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, že xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Zb. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx ohodnotenie xxxxxxxxx bolesti nedosiahne xxxxxxxx 100 bodov.

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

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx xx rozhodnete xxxxxx o xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx vyplňovať body XXX. - XIV. xxxxx dotazníka.

XII. Náklady xxxxxxx s xxxxxxxx xxxxxx:

Xxx o xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. pod xxxxxxxxxx, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx xx ministerstvo xxxxxxxxxxxxxx nebude xxxx xxxx zreteľ.

XIII. Xxxxxxx xxxxxxxxx pomery žiadateľa xxxx x xx xxxxxx xxxx xx xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ xx x zamestnaneckom xxxxxx, xôxxx o potvrdenie xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx neskorších xxxxxxxxx. Xx xx žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx sociálnu situáciu, xxxx potvrdenie o xxxxx xxxxxxxxxx xôxxxxxx. X prípade, že x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx pomery žiadateľa, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x nich xxxxxxx vyhlásením.

XIV. Uveďte xxxxx nemocenských xxxxx (xxxxxxxxxxx dôchodku) x xxxx, odkedy xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx vzniku xxxx xx zdraví, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo poisťovne x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte a xxxxxxx jeho xxxxx.

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

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx xx xxxxxxxxxxx xxxx spôsobenej xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Slovenskej) republike.

Beriem xx xxxxxxx, že xx podľa ust. §12 xxxxxx č. 209/1997 Xx., o xxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x doplnení xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx xxxxx, odviesť xx xxxx Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx škody, a xx až xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x xxx xxxxxx xx vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby sa x mene štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili x xxxxx náhrady, xxxxx xxx xxxxxx(x).

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

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Potom bude xxxxxxxxxx na xxxxxxx xx na inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx mesiacov xx podaní xxxxxxxx x predložení potrebných xxxxxxxx buď xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx x prípade, xx xx v xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Xx xxxx sa považuje xx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela, xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx smrti x xxx xxxx x domácnosti, xxxxx xxxxx, xxxxxx zomretý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 roka xxx xxx, xxx xx obeť dozvedela x xxxxx xxôxxxxxxx xxxxxxxx činom. Ak xxxxx dňom už xxx xx xxx xxxxxxxxx trestného xxxx, xxxx dokazuje xxxxxxx, xxxx xx to xxxxx. Ministerstvo spravodlivosti xxxôxx xxxxxxxx žiadostiam x poskytnutie peňažnej xxxxxx, xxxxx xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Pomoc xx na žiadosť xxxxx, ktorej x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, poskytne x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, ktorá xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, ktoré xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx je vyššia xxx tá, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx pomoci, na xxx xxxxxxx x xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx opäť, x to xx xx xxxxxxxxxx výšky 150&xxxx;000.- Kč; pričom xx xxxxxxxxxx xx xxxxxxx, ktoré už xxxx xxxxxxxxx.

- Fyzickej xxxxx, ktorá je xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx (xx xxxx rodičom, xxxxxxxx alebo xxxxxxxx xxxxxxxxx a xxxxxxx x čase xxxx xxxxx s xxx xxxx v xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Kč; xxxxx xx svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Xx, x xx xx xxxxx obetí viac xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx xxxxxxxx, na xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, xx xxxxx odkazujeme pri xxxxxxxxxxxx položkách. Ak xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx x xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx dôvodom xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx bude žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ je xx xxxxxxx xxxxx odo xxx poskytnutia xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) až xx xxxxx poskytnutej pomoci. Xxxx povinnosť nemá, xx xx škodu xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx na vrátenie xxxxxxxxxxx peňažnej pomoci. Xx takýto xxxxxx xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx výška xxxxx, ktorú xxx xxôxxxxxx, a xxxxx xxxxxxx, xxxxx obeť xxxxxxx.