Plné znění - 241/2006 Sb.

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

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx is xxxxxxxx xxx xxx xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant xx Xxx no. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

_____________________________________________________________________________________________

X. Xxxxxx xxxxxxx xxxx in the xxxxxxxx data xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx criminal xxx who has xxxxxxxx bodily xxxx, xx the xxxxxxxx xx x xxxxxx xxx has died xx xxxxxxxxxxx of xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx applicant xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, a xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx parent) xx xx xxx xxxxx of a xxxxx xx attorney, xxxxxx fill xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx registered xxxxxxx:

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

III. Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx xxx personal xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Last xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx xxxxxxxxx xx x xxxxxxxx of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, please xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx xxxx the xxxxxxxx xxxxxxxxx xx xxx an obligation xx support the xxxxxxxx (xx xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx a xxxxx decision xx xxx xxxxxxxxxx to xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx couples, xxxxxx attach x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx on which xxx crime xxx xxxxxxxxx and, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx a later xxxx, please xxxx xxxxxxx the xxxx xxx xxx xxxxxx xx which xxx xxxxxx xxxxxxx xx xxxx consequences (e.g., xxx date xx xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx reference xxxxxx of xxx xxxx xxxxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx indicate xxx stage xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 of Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx reduced xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx xxxx xxx xx xxx legal xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx xxx xxxxx person xxxxxxxxxxx xxx the xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx if xxx xxxxxxxx has not xxxx xxxxxxxxxx.

______________________________________________________________________________________________

Xxxx xx xxxx VlIl xx xxx applicant xx x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx of the xxxxxxxxx xxxxx.

1. Xxx you x xxxxx, xxxxxx xx xxxxx xx xxx xxxxxx who xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxxxxxx?

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

3. Xxxx you x xxxxxxxxx xx xxx xxxxxx xx xxx xxx deceased obliged xx support xxx?

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

______________________________________________________________________________________________

According xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x survivor xx x xxxxxx who xxxx in consequence xx x xxxxxxxx xxx xx xxxxxxxxxx xx be x xxxxxx xx xx xx xxx xx x parent, spouse xx child xx xxx xxxxxxxx xxx xxxxx xxxx him xx xxx xx xxx same xxxxxxxxx xx xx the xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

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

Xxxxxx xxxxxx x point-based assessment xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx xx xxx xxxxxxxx xx the xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx in xxxx that xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx to xxx provisions xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx will xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx of xxx xxxx xxxxxxxx xx at least 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxx proved xxxxx xx medical xxxxxxxxx xxx xxxx xxxxxx (§7, section 1, xxxxxx x of Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx xx xxxxx xxx a xxxx xxx payment, xxxxx xx xx xxxx xx fill xx xxxxx XII - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx out xx xxx xxxx xx xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx xxxx xxxxx have not xxxx xxxx xx xx xxxxxxxxx company. xx such xxxxxxxx xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may not xxxx them xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx confirming xxxx xxxxx to xxx application.

If xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx from xxx/xxx xxxxxxxx describing xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. lf xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx a xxxx of his/her xxxx xxxxxx tax xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx person xxx xx xxxx to xxxxx his/her xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx xxx xxxxxx xx the xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx the xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be xxxxxx, xx xxxxxxxxxxx cases xx xxxxxxxxx xxx xx attached.

Xx xxxxxx xxxxxxxx has xxxx impaired xx x xxxxxx of xxx xxxxxxxx act xx xxxxx X xxx x victim. X xxxx not xxx xxxx compensated xxx xxx harm 1 xxxx xxxxxxxx xx a result xx xxx criminal xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx lodged xxx xxxxx xxx xxxxxxxxx xxxxxxx xx any xxxxxxx claim for xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx criminal act xx xxx xxxxxxx xxxxx than the Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Coll., xx the xxxxxxxxx xx financial support xxx xxx victims xx xxxxxxxx acts xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxx xxxx suffered, xx xx xxx amount xx xxx xxxxxxxxx xxxxxxx, xxxxxx five xxxxx xxxx xxx xxxx of receiving xxx xxxxxxx xxxxxxx. X xxxx acknowledge xxxx, after xxx xxxxx of xxx xxxx-xxxx period, X xxx xxxx xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx waive xxx xxxxx'x claim xxx xxx xxxxxx of xxx provided support, xxxxxx xxxx a xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx standing, the xxxxx xxxxxx xx xxxx suffered xxx xxx xxxxxx of xxxxxxxxxxxx xxxxxxxx.

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

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

Signature xx xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx xx the xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xxxxxxxx xx Xxx No. 209/1997, xxx Ministry xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall initiate xx investigation xxxx xxx police xx x xxxxxxx xxxxxxxxx xx per xxx xxxxxxxx details xx xxx xxxx. Within xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx xx xxx application xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, the Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx support xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- The applicant xxxxx be considered x victim xx xxx Act Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx the commitment xx x xxxxx. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x receipt of xxxxxxxx support xxxxx xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffercd (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx at xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx in xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx be x xxxxxx xx xxx xxxxxxxx xx a xxxxxx, xxxxxx xx xxxxx of xxx xxxxxxxx xxx xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx xx the xxxx of xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx provision xx xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx date xx xxxxx xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx. Xx xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx xx xxx commitment of xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx meet an xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx received anytime xxxxx the lapse xx the xxxxxxxxxxxxxx xxxxxx.

- Financial xxxxxxx xx applied for xx a victim xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x crime xxx xx in xxx xxxx xx x xxxx xxx amounting xx XXX 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx xxx xxxxx of medical xxxxxxxxx xx xxxxxx xx xxx xxxxxx, xxxxxxx by xxx xxxxxx previously xxxx xx xxx victim xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx not exceed XXX 150,000. If, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx proves that xxx harm xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx receive xxxxxxxxxx xxxxxxx up xx xxx amount of XXX 150,000 if xx/xxx applies xxx xx within the xxxxxxxxxxxxxx xxxxxx of xxxx (i.e., 1 xxxx from xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx the harm xxxxxx xx the xxxxx); xx xxxx xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx xx x xxxxxx who xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx time xx xxx/xxx xxxxx or xxxxxxxxx by xx xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx with x xxxx xxx xxxxxxxxx xx CZK 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx number xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx replace xxx xxxxxxxxx of the xxxxxxxxx liability xx xxxxxxxxx xx motor xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx matters xxxxxxx xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx xx xxx xxxxxxxx xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx in xxxxxxxx xxxxx, in xxxx xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please xxxx xx xxxx that xxx available xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx must be xxxxxxxx xx the xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx application. Xxxxxx xxx xxxxxxxxx fail xx deliver xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x decision xx withhold xxx xxxxxxx xx per Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, prejudice xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Please xxxx xx mind xxxx xxx xxxxxxxxx xxxxx be xxxxxxx xx return any xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (from xxx xxxxxxxx, xxxxxxxx etc.) xx the account xx the Xxxxxxxx xx Xxxxxxx up xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx has xxx received any xxxxxxxxxxxx. Xx so xxxxxxxxx xx the xxxxxx in an xxxxxxxxxxx, the Ministry xx Justice xxx xxxxx the xxxxx'x xxxxx xx xxxxx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx of xxx xxxx-xxxx xxxx, provided xxxx x xxxxxx xx justified xx xxx xxxxxx'x xxxxxx xxxxxxxx, the xxxxx xxxxxx of xxx xxxx xxxxxxxx and xxx amount of xxxxxxxxxxxx xxxx xx xxx victim.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx v xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

______________________________________________________________________________________________

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx adresa (v xxxxxxx, že xx xxxx od 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 dohody x xxxxx moci, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Preto x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x prípade xxxxxxxxx xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

XXX. Ak xxxxxxxľ xxxxx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, aj xxxxx o xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Posledné bydlisko:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx zomretá xxxxx v xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, osoba xxxxxx x spoločnej domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx v dôsledku xxxxxxxxx činu xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu xxxxx - xxxxx xôxxx x rodný xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx takou xxxxxxxx bude sobášny xxxx x xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx na peňažný xxxx; x takom xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx trestného činu x ak xx xxxx x škode xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx a ako (xxxxxxxxx z lekárskej xxxxxx - dátum xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx konaní (policajný xxxxx, xxxxxx zastupitelstvo, xxx), ktorý naposledy xxxxx xxxxxxx x xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, ktoré xxxx predstavu x xxx, v xxxx xxxxxx sa xxx xxxxxxxx (napr. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx xxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx inej xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx ustanovenia §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, či xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx na xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx VIII. Vyplňte, xx xxxxxxxľ je xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, či ste xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 zákona č. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

1. Xxxx xxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx zomrela v xôxxxxxx trestného činu?

2. Xxxx ste s xxxxxx trestného xxxx xxxx vykonaním trestného xxxx x xxxxxxxxx xxxxxxxxxx?

3. Xxxxxxxxxxx Vám xxxx trestného xxxx xxxxxx, xx xxxx x tomu povinná?

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

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť xxxxxxxx xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak je xxxxxxx, xxxxxxxx alebo xxxxxxxx zomretého x xxxxxxx x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx alebo osoba, xxxxxx nebohý xxxxxxxxxx xxxxx bol povinný xxxxxxxxxx xxxxxx.

______________________________________________________________________________________________

Xxxx XX. xx XXX. Xxxxxxx, xx sa xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x bola xx xxôxxxxxx xxxx xx xxxxxx.

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

X. Celková xxxxx bodového xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx xx xxxx xxxxxxxx bodové xxxxxxxxxxx xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx od xxxxxx, ktorý ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx bude obsahovať xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x bodové xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx bodové ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Podľa xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx žiadosť xxxxx xxxxx poskytnúť peňažnú xxxxx xx výške xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx xx xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

XIII. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx x po xxxxxx xxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Zb., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx je žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, že x nejakého xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx ich xxxxxxxľ poberá, či xxxxxxx po vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. X xxxxxxx, xx x dôsledku xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx činom Xxx xxxxxxxx invalidný xôxxxxxx, xxxxxx x xxxxxxx jeho výšku.

Xxxx majetkové pomery xx xxxx, xx xxxxxxxx činom, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Škodu, xxxxx xx xxxxx xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx inom xxxxx xxx v Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx xxxľx xxx. §12 zákona x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej činnosti x x zmene x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx rokov xxx xxx, keď xx xxxxxxxx pomoc, xxxxxxx xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx xx xx xxxxx poskytnutej xxxxxx. Xxxxxxx s xxx xxxxxx xx xxxxxxx, xx po uplynutí xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx poskytnutej pomoci, xx moja sociálna xxxxxxxx xxxx taký xxxxxx odôvodňovať, xxxxxxx xxxxx škody, ktorú xx spôsobili x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 odst. 1 písm. x) xxxxxx č. 200/1990 Xx., x xxxxxxxxxxxx, x znení neskorších xxxxxxxxx.

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

xxxxxx žiadateľa alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx poradové xxxxx. Xxxxx xxxx xxxxxxxxxx na xxxxxxx xx xx inom xxxxxxxx orgáne xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X zmysle zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx obeť xxx x prípade, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx poškodenie xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx podmienkou xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 bodov. Za xxxx sa xxxxxxxx xx xxxxx xxxxxxxxx xx obeti, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xxxx rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x zároveň x xxxx xxxx xxxxx x ním žila x xxxxxxxxxx, xxxxx xxxxx, ktorej zomretý xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx dňa, keď xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx je xxx xxxxxxxxx trestného xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx to xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx uplynutí xxxxxxxxxx lehoty.

- Pomoc xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, poskytne x xxxxxxxxx xxxx 25 000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx na xxxxxxx, xxxxxxxxxx náklady xxxxxxx x liečením, xxxxxxx o xxxxx xxxxxxxx čiastok, xxxxx xxxx x titulu xxxxxxx xxxxx už xxxxxxx; xxxxx xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - xx xxx, xxx jej poskytli xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx xx vyššia xxx tá, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx v xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx xxxxx xxxxxxxxx pomoc opäť, x xx až xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; xxxxxx xx prihliadne xx xxxxxxx, ktoré už xxxx xxxxxxxxx.

- Fyzickej xxxxx, xxxxx xx xxxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx (xx bola xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň x xxxx xxxx xxxxx s xxx xxxx x domácnosti, xxxxx jej xxxxxxx xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx výživu), xx poskytne peňažná xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Kč; xxxxx xx xxxxxx xxxxx xxxxxx presiahnuť xxxx 450 000.- Xx, x xx je xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. nenahradzuje inštitút xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx plnenia. Xxx x celkom ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x potvrdenia, na xxxxx xxxxxxxxxx pri xxxxxxxxxxxx položkách. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx spravodlivosti nemôže xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx x xxxxxxx ani xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, že xx xxxx xxxxxxxľxxx xxxxxxxxxx peňažná pomoc, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx poskytnutia xxxxxx xxxxxxx xx účet xxxxxxxxxxxx spravodlivosti xxxx, xxxxx dostal xxx xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx do xxxxx poskytnutej xxxxxx. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx vzdať xxxxx na vrátenie xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, ktorú jej xxôxxxxxx, x výška xxxxxxx, ktorú xxxx xxxxxxx.