Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Provision xx Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Criminal Xxxx pursuant xx Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx xxxxxxxxx xxxxxxx to xxx xxxxxxx xx criminal xxxx xxx on xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx questions in xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx xxxxxxxxxxxxx xx xxxxxxxx for the xxxxx xxxxxxxxxx xx xxxx application for xxx xxxxxxxxx xx xxxxxxxxx support pursuant xx Xxx xx. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx is highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx the xxxxxxxx xxx who xxx xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx xxx died xx consequence xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx address:

5. Mail xxxxxxxx address (should xx xxxxxx from xxx permanent address, xxxx):

6. Phone Xxxxxx:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("representative") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx on xxx xxxxx xx a xxxxx xx attorney, xxxxxx fill xx xxx xxxx xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx representative xx xxxxxx xxx application xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx submit x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx x xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a xxxx xx xxx xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx equivalent xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx a xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx the xxxxxxxx xxxx of the xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Last xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx deceased xx the applicant (x.x. xxxxxx, xxxxxxxx, xx xxxxxxxxxx xxxxxx xx xxxxxx household)

If xxx xxxxxxxxx xx x survivor xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that the xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx xxxxxxx the xxxxxxxx (in xxx xxxx xx a xxxxxx-xxxxx xxxxxxxxxxxx, such xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx couples, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx on which xxx xxxxx xxx xxxxxxxxx and, xx xxx victim learned xxxxx xxx xxxxxxxxxxxx xx xxx crime xx a xxxxx xxxx, xxxxxx also xxxxxxx the date xxx xxx xxxxxx xx which xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx date xx xxx medical xxxxxx).

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

Xx xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice xxxxxxxxx xxxxx could xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx prosecution, xxxx xx the indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx xxxxxx of xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx xxxx use xx all legal xxxxxxxx xx xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx xxx xxxxx xxxxxx xxxxxxxxxxx xxx the xxxx xxxxxxxx. Xx xxx xxxx in this xxxx if xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx applicant xx x xxxxxxxx xx xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx crime.

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

2. Xxx xxx xxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx xxxxx xx xxx commitment xx xxx crime?

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

4. Xx any xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Xxxxxx give xxxxx xxxxxx, if xxxxx xx xxx.

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Xxxxxxxxx xx the xxxxxxxxxx xx §2, xxxxxxx 2 of Act xx. 209/1997, a xxxxxx xxx xx x survivor of x victim xxx xxxx xx xxxxxxxxxxx xx x criminal xxx xx considered xx xx x xxxxxx xx xx xx xxx xx x parent, spouse xx xxxxx xx xxx xxxxxxxx and xxxxx xxxx him xx xxx xx xxx xxxx household xx if the xxxxxx xxx x xxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxxxx xxx xxxxxxxx xx support the xxxxxx.

Xx the xxxxxxxxx xx the victim xx a xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx in xxxxx XX - XIV.

Please xxxxxx x point-based xxxxxxxxxx xx xxxx and xxxxxxxxx xxxxxxxx to Xxxxxx No. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx should be xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx of the xxxxxx'x xxxxxx position. Xxxxxx xxxx in xxxx xxxx xxxx xxx xxxxx-xxxxx assessment xx xxx xxx xxxxxxxx is relevant xxx the xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx xx xxx provisions xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx xxx xxxxx assessment of xxx pain suffered xx xx least 100 points.

Xxx xxxxxx may xxxxxx xxxx xxx financial xxxxxxx xx the xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx medical xxxxxxxxx xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). xx you xxxxxx xx xxxxx xxx a xxxx xxx payment, xxxxx xx xx need xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx xxx in xxx home xx xxxx xxxxxxx treatment, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx xx xx insurance xxxxxxx. xx xxxx expenses xxx not proved xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx them xxxx xxxxxxxxxxxxx.

Xxxxxx attach xxx documents xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx according xx §351 xx. xxx. of Act xx. 262/2006, xxx Xxxxx Xxxxxx Code, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be a xxxx xx xxx/xxx xxxx recent xxx xxxxxx. lf xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx to xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx the xxxxxx xx the xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x income xxxxxxxxx xxxxxx be proven, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx may xx attached.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x xxxxxx xx xxx xxxxxxxx xxx xx xxxxx X xxx x xxxxxx. X xxxx not xxx been xxxxxxxxxxx xxx xxx harm 1 xxxx xxxxxxxx xx a xxxxxx xx xxx xxxxxxxx xxx.

X xxxxxx affirm xxxx X xxxx xxx xxxxxx any xxxxx for xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx for the xxxx suffered xx x result xx xxx xxxxxxxx xxx xx xxx country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Xxxx., xx xxx provision xx xxxxxxxxx support xxx xxx victims xx xxxxxxxx xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, I xx obliged xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx the xxxx suffered, xx xx the amount xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx of receiving xxx funding xxxxxxx. X xxxx acknowledge xxxx, xxxxx the xxxxx of the xxxx-xxxx period, I xxx file an xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx waive the xxxxx'x xxxxx xxx xxx xxxxxx xx xxx provided support, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, the xxxxx extent xx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx information xx xxxxxxxxxxx information for xxx xxxxxxxx of xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent 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 applicant xx xxx/xxx representative

- Upon xxxxxxx xx xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police or x xxxxxxx authority xx xxx xxx xxxxxxxx details xx xxx case. Xxxxxx xxxxx months from xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx either xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- The xxxxxxxxx xxxxx be xxxxxxxxxx x xxxxxx xx xxx Act Xx. 209/1997 Coll. only xx xx/xxx xxx xxxxxxxx xxxxxx harm xx x xxxxxx xx xxx commitment xx x xxxxx. X xxxxxxxxx xxx xxx the xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx support shall xx xxx xxxxxx xx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx xxxxxxxxx of xxxxxx position), which xxxx be at xxxxx 100 points. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx xx xxxxxxxxxx xx be x xxxxxx xx the xxxxxxxx xx a xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx xxx xxxxxxxx xxxxxx a xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx or if xxx xxxxxxxx xxxxxxxxx xx was xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Coll. on xxx provision of xxxxxxxxx support xx xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx xxxx xx 1 xxxx from xxx xxxx on xxxxx the victim xxxxxxx xx the xxxx xxxxxx by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx crime, the xxxxxx xxxxx provide xxxxxxxx xx the xxxx on which xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx the abovementioned xxxxxx.

- Financial xxxxxxx xx applied for xx x victim xxx has xxxxxxxx xxxxxx xxxx xx x result xx xxx xxxxxxxxxx xx x xxxxx may xx xx xxx xxxx xx a xxxx xxx amounting xx CZK 25,000 xx xx xxxxxx xxxxx to lost xxxxxx xx xxx xxxxx xx medical xxxxxxxxx xx xxxxxx xx the victim, xxxxxxx xx xxx xxxxxx previously xxxx xx the xxxxxx xx xxxxxxxxxxxx xxx xxx harm xxxxxxxx. Xxx xxxxx xxxxxx xx such support xxxx not exceed XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx xxxxxxx, the xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx the amount xxxxxxxx, xxx victim xxx xxxxxxx xxxxxxxxxx xxxxxxx up xx xxx amount of XXX 150,000 xx xx/xxx applies for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx of xxxx (x.x., 1 xxxx xxxx xxx xxxx on xxxxx xxx victim learned xx the xxxx xxxxxx by xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- An xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx has xxxx as a xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx xxxxx xx the deceased xxxxxx in x xxxxxx xxxxxxxxx xxxx xxx deceased xx xxx xxxx xx xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx to be xxxxxxxxx xx the xxxxxxxx) shall xx xxxxxxxx xxxx x xxxx sum xxxxxxxxx xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx as financial xxxxxxx shall not xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx victims xxxxxx xxxxx, the xxxxxx xxxxxxxx per xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Coll. xxxx xxx replace the xxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx xxxxx xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx isolated xxxxx, in xxxx xx exceptional circumstances, xxx xx application xxx xxx provision xx xxxxxxxxx xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx mind that xxx available xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx must xx xxxxxxxx to xxx xxxxxxxxxxx. If xxx xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx fail xx deliver xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx deadline, xxxx xxxx xxx xxxxxxx x decision xx xxxxxxxx xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, prejudice xxx xxxxxx of xxxxxxx application.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxxx (xxxx the xxxxxxxx, insurers xxx.) xx the xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx the xxxxxx xx xxx support xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx apply xx he/she xxx xxx received xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx by xxx xxxxxx in an xxxxxxxxxxx, the Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx return xx xxx xxxxxxxxx support xxxxxxxx after the xxxxx xx the xxxx-xxxx xxxx, provided xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx of xxx xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx xx xxx victim.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx v xxxxxxxx, x ktorej xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. V xxxxxx xxxxxxxx posúdenia Xxxxx xxxxxxxx x xxxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám za xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx na xxxxxx, xxxxx xxxxx xxxxxxxxxx xx osobe, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) na xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx základe dohody x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx kópiu xxxxx moci (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx rodného xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, xxxxxxx, prosím, xx xxxxx x xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. V xxxx xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx x xxxxx žiadateľa (xxxx, xxxxx, osoba xxxxxx x xxxxxxxxx domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela, x žiadosti xx xxxx priložiť xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré dokladajú xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x rodný xxxx xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx žiadate xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx xxxxxxx xxxx; v xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx účtu.

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

Uveďte dátum xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x škode xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x ako (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný x xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx čine. Uveďte xx spisovú xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx x xxx, x akom xxxxxx sa xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

VII. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx xxxxx xx xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx xx môže xxxxxx xxxxx sa xxxxxxxx x prihliadnutím xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku na xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Tento xxx nevyplňujte, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx VIII. Vyplňte, xx žiadateľ xx xxxxxxxxxx xx osobe, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 xxxxxx č. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx podmienky, xx xx Vám xxxxx xxxxxxxxxxx xxxxx.

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

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

3. Poskytovala Xxx xxxx xxxxxxxxx činu xxxxxx, xx xxxx x tomu povinná?

4. Xxľxxxx další xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Xxxxxx xxx počet, ak Xxx je xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx xxxx považuje xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak je xxxxxxx, manželom alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx alebo xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body IX. xx XXX. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx trestného xxxx a xxxx xx xxôxxxxxx xxxx xx xxxxxx.

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

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx xxxxxx činí:

K xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx bolesť podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 odst. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 bodov.

XI. Xxxxxx, xx xxxxxxx x poskytnutie xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25 000.- Xx xxxxx xx xxxxxxxx xxxxx xxxxxx xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. x) xxxxxx 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 xx xxxxxxxx x ušlému xxxxxxx. Xx xx rozhodnete xxxxxx x peňažnú xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Náklady xxxxxxx x liečením xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx xxxxx x xxxxxxxxxx xx xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx tieto xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx náklady xx xxxxx xxxxxxx, inak xx ne ministerstvo xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

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

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré potvrdzujú xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx žiadateľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x priemernom xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx napríklad opis xxxxxxxxxx daňového xxxxxxxxx. Xx žiadateľ poberá xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx prípade xx xxxxx nahradiť xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx dôchodku) a xxxx, odkedy xxx xxxxxxxľ poberá, či xxxxxxx xx xxxxxx xxxx xx zdraví, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. V prípade, xx x dôsledku xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx jeho xxxxx.

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

Xxxxxx vyhlasujem, že xxxxx xx peňažnú xxxxx xx obdobný xxxxx na odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx neuplatnil(a) x žiadnom inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx podľa ust. §12 xxxxxx x. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, ktoré xxx dostal(a) ako xxxxxxx xxxxx, a xx xx do xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx na xxxxxxx, xx po xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx xxxxxxxx xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx tiež xx xxxxxxx, xx xxxxxxxxx uvedením nesprávneho xxxxx neúplného xxxxx xx xxxx zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 odst. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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xxxxxx žiadateľa alebo xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx poradové xxxxx. Potom bude xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx okolností prípadu. Xx troch xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx alebo žiadateľovi xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx poskynúť.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx x prípade, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Za xxxx xx považuje xx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x zároveň v xxxx jeho smrti x xxx žila x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x škode xxôxxxxxxx xxxxxxxx činom. Xx xxxxx xxxx xx xxx je deň xxxxxxxxx trestného xxxx, xxxx xxxxxxxx xxxxxxx, xxxx sa xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx po xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, ktorej v xôxxxxxx trestného xxxx xxxxxxx škoda xx xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx vo xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx na xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o súčet xxxxxxxx xxxxxxx, ktoré xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - po xxx, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx tá, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx žiadosť v xxxxxx xxxxxxxxxx týmto xxxxxxx jej xxxxx xxxxxxxxx xxxxx xxäx, x xx až xx maximálnej xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx už xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, ktorá je xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu xxxxxxx (xx bola xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx peňažná xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx xx svojom xxxxx xxxxxx presiahnuť xxxx 450 000.- Xx, x ak xx xxxxx xxxxx xxxx xxx xxx osoby, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx dopravných xxxôx žiadať subjekt, xxxxx spravuje poistenie xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx je možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Ak xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx bude xxxxxxxľxxx xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx poskytnutia pomoci xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal xxx xxxxxxx xxxxx (od xxxxxxxľx, xxxxxxxxx x xxx.) až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx xxxx, xx mu škodu xxxxxxxxxx. Xx základe xxxxxxxx obete xx xxxxxxxxxxxx spravodlivosti xôxx x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx obeť xxxxxxx.