Plné znění - 241/2006 Sb.

Questionnaire xxx the Assessment xx Xxxxxxxxxxxx xxx xxx Provision xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx of Criminal Xxxx xxxxxxxx xx Xxx No. 209/1997 Xxxx., xx the xxxxxxxxx xx fulancial xxxxxxx to xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx certain xxxxx xxxx, as amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx in xxxx xxxxxxx situation. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx xxx the xxxxx assessment of xxxx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx is xxxxxx xxxxxxxxxxx.

_____________________________________________________________________________________________

X. Xxxxxx legibly xxxx xx xxx xxxxxxxx xxxx xx xxx applicant - x.x. the victim xx xxx criminal xxx xxx has xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx of xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

5. Xxxx xxxxxxxx address (should 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 ("xxxxxxxxxxxxxx") xx the xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx instance, a xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx the xxxxx of x xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx applicant, xxxxxx xxxx xxxxxx x xxxxxxxx authorizing xxx/xxx xx represent xxx xxxxxxxxx - a xxxx of a xxxxx xx attorney (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a copy xx the xxxxx xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx document.

III. Xx the applicant xx a survivor xx x xxxxxx xxx has xxxx xx consequenee xx xxx xxxxxxxxxx criminal xxx, xxxxxx xxxx xx the personal xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Given xxxx:

3. Date of xxxxx:

4. Date xx xxxxx:

5. Last permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxxx (x.x. xxxxxx, daughter, xx xxxxxxxxxx xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx is x survivor of x person who xxxx xx xxxxxxxxxxx xx the criminal xxx, xxxxxx xxxxxx x copy xx xxx xxxxx xxxxxxxxxxx xxx xxx documents xxxxxxx that the xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx xxxxxxx the xxxxxxxx (xx xxx xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx decision xx xxx obligation xx xxxxxxx the dependent; xx xxx case xx married couples, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify xxx xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx xxx consequences xx xxx crime xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx xxx date xxx xxx manner xx xxxxx the xxxxxx xxxxxxx xx xxxx consequences (x.x., xxx date xx xxx xxxxxxx report).

VI. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x office, xxxxx) xxxxx xxxx recently xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx reference xxxxxx of the xxxx xxxxxxx to xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx decision xx xxx abovementioned xxxxxxxx xxxxxxx authority xxxxx could indicate xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. resolution xx xxx discontinuation of xxxxxxxx prosecution, copy xx the xxxxxxxxxx, xxxxxxxxx - final xx xxxxxxxxx).

According xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx may xx reduced or xxxxxxxx depending xx xxxxxxx xxx xxxxxx xxx made xxx xx all xxxxx xxxxxxxx to xxxxxxx x xxxxx xxx xxxxxxxxxxxx against the xxxxxxxx xx xxx xxxxx person responsible xxx xxx harm xxxxxxxx. Xx xxx xxxx xx this xxxx if the xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

______________________________________________________________________________________________

Xxxx xx xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx xx xx individual xxx xxx xxxx in xxxxxxxxxxx xx the xxxxxxxxx xxxxx.

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

2. Xxx xxx live xx a common xxxxxxxxx xxxx the xxxxxxxx person xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

3. Xxxx you a xxxxxxxxx xx xxx xxxxxx xx was xxx deceased obliged xx xxxxxxx xxx?

4. Xx xxx xxxxx xxxxxxx xxxx the xxxxxxxxxx described in xxxxxxx 1 xx 3? Please give xxxxx number, if xxxxx to xxx.

______________________________________________________________________________________________

Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, x xxxxxx who is x survivor xx x xxxxxx xxx xxxx in consequence xx x criminal xxx xx xxxxxxxxxx xx xx x xxxxxx xx he xx xxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx with xxx xx xxx xx xxx xxxx xxxxxxxxx xx if the xxxxxx was x xxxxxxxxx xx the xxxxxxxx or xxx xxxxxxxx was xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx xxx applicant xx xxx xxxxxx xx x xxxxx xxx xxx suffered xxxxxx harm, xxxxxx xxxx in xxxxx XX - XXX.

Please attach x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx for xxx xxxxxx'x treatment. Xxxx xxxxxxx report xxxx contain x xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx a point-based xxxxxxxxxx of xxx xxxxxxxx of xxx xxxxxx'x xxxxxx position. Xxxxxx xxxx in xxxx xxxx only xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Act xx. 209/1997. According xx xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act xx. 209/1997, xx financial xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx of xxx xxxx xxxxxxxx xx at xxxxx 100 points.

Xxx xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx xx CZK 25,000 xx an xxxxxx equal xx xxx proved costs xx xxxxxxx treatment xxx lost xxxxxx (§7, section 1, xxxxxx x of Xxx Xx. 209/1997 Xxxx.). lf xxx xxxxxx xx xxxxx xxx a xxxx xxx payment, xxxxx xx xx xxxx xx xxxx in xxxxx XII - XxX.

Xxxx includes xxx expenses xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx xx xxxx xxx in xxx home or xxxx medical xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx such xxxxx have xxx xxxx xxxx xx xx xxxxxxxxx company. xx such xxxxxxxx xxx xxx proved xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx not xxxx them into xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx an xxxxxxxx, xxxxx documents xxxxx xxxxxxx x xxxxxxxxx xxxx his/her xxxxxxxx xxxxxxxxxx the xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Act xx. 262/2006, xxx Xxxxx Labour Code, xx xxxxxxx. lf xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx x xxxx of his/her xxxx xxxxxx tax xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx able xx xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx the amount xx xxx retirement xxxxxxx. lf xxx xxx reason the xxxxxxxxx'x income xxxxxxxxx xxxxxx be xxxxxx, xx exceptional xxxxx xx affidavit may xx xxxxxxxx.

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

X xxxxxx xxxxxx xxxx I have xxx lodged xxx xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx xxxxx for xxxxxxxxxxxx xxx the xxxx suffered xx x result of xxx criminal xxx xx xxx country xxxxx xxxx the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according xx §12 xx Act Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, I xx obliged to xxxxxxxxx the Xxxxxxxx xx Justice xxx xxxxxx received xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx, xx xx the xxxxxx xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx from xxx xxxx of receiving xxx xxxxxxx xxxxxxx. X also xxxxxxxxxxx xxxx, after xxx xxxxx xx xxx xxxx-xxxx xxxxxx, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx provided xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx consciously xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx information xxx xxx purposes of xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx c) xx Xxx no. 200/1990 Xxxx., xx xxxxxxxx xx amended.

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

Signature xx xxx applicant xx xxx/xxx representative

- Xxxx xxxxxxx xx the xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx xxxxx initiate xx investigation xxxx xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxx case. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx of xxx xxxxxxxxxxx xxx xxxxxxxxxx of xxx xxxxxxxxx documents, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx the support xx xxxxxx xxx xxxxxxxxx xx the xxxxxxx why such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx applicant xxxxx xx xxxxxxxxxx x xxxxxx as xxx Act Xx. 209/1997 Xxxx. only xx xx/xxx has xxxxxxxx xxxxxx harm xx x xxxxxx xx xxx commitment xx x xxxxx. X xxxxxxxxx xxx xxx the ohly xxxxxxxxx xxx xxx xxxxxx'x receipt xx xxxxxxxx xxxxxxx xxxxx xx the xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx the xxx suffercd (not xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx consequence xx x crime xxxxx xx xxxxxxxxxx xx be a xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx shared a xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx provision of xxxxxxxxx xxxxxxx xx xxxxxxx of criminal xxxx stipulates x xxxxxxxxxx xxxx xx 1 year from xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx of xxx xxxx caused xx xxx xxxxx. If xxxx xxxx xxxx xxx xxxxxxxx with xxx xxxx of xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx of Justice xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx received xxxxxxx xxxxx xxx lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx as x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx xxx xx in the xxxx xx x xxxx xxx xxxxxxxxx xx XXX 25,000 xx an xxxxxx xxxxx to xxxx xxxxxx or the xxxxx xx xxxxxxx xxxxxxxxx xx proved xx the victim, xxxxxxx xx any xxxxxx xxxxxxxxxx xxxx xx the victim xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx xxxxxx xx XXX 150,000 xx xx/xxx applies xxx xx within the xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx from xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- An xxxxxxxxxx xxx is a xxxxxxxx of a xxxxxx xxx has xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx a xxxxx (x xxxxxx, xxxxxx xx child xx xxx deceased xxxxxx in a xxxxxx household xxxx xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx by xxx xxxxxxxx) xxxxx be xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx total amount xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx per xxxxxx xxxxx be xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx replace xxx xxxxxxxxx xx xxx xxxxxxxxx liability xx xxxxxxxxx xx motor xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx related xx traffic xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx should xxxx xx directed xx xxx xxxxxxxx xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx the provision xx financial xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx xxxx xxxx xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx xxxxxxxx xxx the respective xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx of Xxxxxxx xxxxxx properly xxxxxxx xxx application. Xxxxxx xxx xxxxxxxxx fail xx xxxxxxx xxx xxxx documents and xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx may xxxxxxx x xxxxxxxx xx xxxxxxxx any xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx in mind xxxx xxx xxxxxxxxx xxxxx be xxxxxxx xx xxxxxx any xxxxxxxxx xxxxxx received xx compensation xxx xxxx (from xxx xxxxxxxx, xxxxxxxx xxx.) xx the xxxxxxx xx the Ministry xx Justice xx xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx xx claim xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx the xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx justified xx xxx victim's xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx the xxxx suffered and xxx amount xx xxxxxxxxxxxx xxxx xx xxx victim.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, že v xxxxxxxx, x ktorej xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti xxxľx zákona č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx ceníme.

______________________________________________________________________________________________

I. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx x žiadateľovi - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx zastúpenia (xxxx. maloleté xxxxx xxxxxx rodičom) alebo xx základe dohody x xxxxx moci, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx k xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx zastúpení) xxxxx xxxxx xxxxxxx xxxxx (x prípade zákonného xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

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

Xx xx žiadateľ osobou xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, x xxxxxxxx sa xxxx xxxxxxxx kópia xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx pozostalú xxxxx alebo mala xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - dieťa pôjde x xxxxx xxxx xxxxx rozhodnutie xxxx x vyživovacej povinnosti, xxx xxxxxxxx xxxxx xxxxxxxx bude sobášny xxxx a xxx.)

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

X. Xxxxxx xxxxx, kedy xx xxxx dozvedela x xxxxx xxôxxxxxxx xxxxxxxx činom.

Uveďte xxxxx xxxxxxxxx xxxxxxxxx činu x xx xx xxxx o xxxxx xxx xxôxxxxxxx dozvedela xx xxxxôx, xxxxxx xxxx x ako (xxxxxxxxx z xxxxxxxxx xxxxxx - dátum xxx vystavenia).

VI. Xxxxxxx xxxxx činný v xxxxxxxx konaní (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý naposledy xxxxx konanie x xxxxxxxx čine. Uveďte xx xxxxxxx xxxxxx, xxx ktorou prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx v xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx o xxx, x xxxx xxxxxx sa xxx xxxxxxxx (xxxx. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x žiadosti.

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

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Zb)., peňažitá xxxxx sa môže xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Tento xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx žiadateľ je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, či xxx xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx uvedené x §2 odst. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx osoby, xxxxx zomrela x xôxxxxxx trestného xxxx?

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

3. Xxxxxxxxxxx Xxx xxxx trestného činu xxxxxx, či xxxx x xxxx xxxxxxx?

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

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť považuje xxxxx xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak je xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx xxxxx osoba, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

______________________________________________________________________________________________

Body XX. xx XIV. Xxxxxxx, xx sa xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx a xxxx xx spôsobená xxxx xx xxxxxx.

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

X. Xxxxxxx xxxxx bodového ohodnotenia xx xxxxxx činí:

K xxxxxxxx xx musí xxxxxxxx xxxxxx ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx ho xxxxxxxxx. Xxxxx lekársky xxxxxxx xxxx obsahovať xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, xx xxx účely zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 bodov.

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

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx obete xxxxx xxxxxxxxx xxxxxxx xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na xxxxxxxx x xxxxxx xxxxxxx. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x domácnosti či xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, x xxx. pod xxxxxxxxxx, xx tieto náklady xxxxxxxxx xxxxxxxxx. Tu xxxxxxx náklady sa xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

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

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ xx x zamestnaneckom pomere, xôxxx o potvrdenie xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. zákona x. 262/2006 Zb., xxxxxxxx práce, x xxxxx xxxxxxxxxx predpisov. Xx xx žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx napríklad opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, xx x nejakého závažného xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx žiadateľa, x krajnom xxxxxxx xx možné nahradiť xxxxxxxxxx x nich xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx nemocenských xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx ich xxxxxxxľ poberá, či xxxxxxx xx xxxxxx xxxx xx zdraví, xxôxxxxxxx trestným xxxxx.

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

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx na odškodnenie xxxx spôsobenej trestným xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx ako x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx vedomie, že xx podľa xxx. §12 xxxxxx č. 209/1997 Xx., x xxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, keď xx xxxxxxxx pomoc, xxxxxxx xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, a xx až xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x tým xxxxxx xx xxxxxxx, xx po xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, xxx xx x mene štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili x xxxxx náhrady, ktorú xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx nesprávneho xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx účelom získania xxxxxxxxxxxx xxxxxx, sa xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 písm. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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

xxxxxx žiadateľa xxxxx xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx xxxxxxxxx po xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx na xxxxxxx xx xx xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx xxxxxx žiadosti x xxxxxxxxxx potrebných xxxxxxxx buď xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx obeť xxx x prípade, xx mu x xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (nie xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx obeti, xxxxx x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx jeho xxxxx x ním žila x xxxxxxxxxx, xxxxx xxxxx, ktorej zomretý xxxxxxxxxx xxxxx xxx xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx dňa, xxx xx obeť dozvedela x škode xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx dňom xx xxx xx xxx xxxxxxxxx trestného činu, xxxx dokazuje okamžik, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx vyhovieť žiadostiam x xxxxxxxxxxx peňažnej xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Pomoc xx xx žiadosť xxxxx, ktorej v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x liečením, xxxxxxx x súčet xxxxxxxx xxxxxxx, ktoré xxxx z xxxxxx xxxxxxx xxxxx už xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx xxx, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx podkladom xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx jej xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Kč; pričom xx xxxxxxxxxx xx xxxxxxx, ktoré už xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx po obeti, xxxxx x dôsledku xxxxxxxxx xxxx zomrela (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx, xxxxx jej zomretý xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne peňažná xxxxx v paušálnej xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx nesmie presiahnuť xxxx 450&xxxx;000.- Kč, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx xxxxxx obeti xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx xxxxxxxx, na xxxxx nadväzuje xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať xxxxxxx, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx plnenia. Len x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx.

- Pripomíname, že xx nevyhnutné xxxxxxxx xxxxxx dostupné doklady x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx žiadosť. Xx xxxxxx potvrdenia a xxxxxxx xxx dodatočne xxxxxx, xxxx xxxxxxxxxx xôxx byť xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Upozorňujeme, xx xx bude xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je xx xxxxxxx rokov xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx povinnosť nemá, xx xx škodu xxxxxxxxxx. Na xxxxxxx xxxxxxxx obete xx xxxxxxxxxxxx xxxxxxxxxxxxxx môže x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx postup xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, x xxxxx xxxxxxx, ktorú obeť xxxxxxx.