Plné znění - 241/2006 Sb.

Questionnaire xxx the Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Provision xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx of Criminal Xxxx xxxxxxxx xx Xxx No. 209/1997 Xxxx., on the xxxxxxxxx xx xxxxxxxxx xxxxxxx to the xxxxxxx xx criminal xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx in xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx xx xxxxxxxx for xxx xxxxx assessment xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx no. 209/1997. Thank xxx xxx xxxx cooperation; xx is xxxxxx xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx victim xx xxx xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx the xxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx a xxxxx of xxxxxxxx, xxxxxx xxxx in xxx xxxx of xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx is xxxxxx xxx xxxxxxxxxxx xx xxxxxx xx xxx applicant, please xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx him/her xx xxxxxxxxx the xxxxxxxxx - x xxxx xx a xxxxx xx attorney (xxx contractual representation) xx x xxxx xx xxx birth xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx the xxxxxxxxx xx x xxxxxxxx xx x person xxx has xxxx xx xxxxxxxxxxx of xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx of xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

If xxx xxxxxxxxx is x survivor xx x person who xxxx xx consequence xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x xxxx of xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include birth xxxxxxxxxxxx or x xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx certificate).

Xxxxxx specify the xxxx on which xxx xxxxx xxx xxxxxxxxx xxx, if xxx xxxxxx learned xxxxx the xxxxxxxxxxxx xx xxx crime xx x xxxxx xxxx, please xxxx xxxxxxx xxx xxxx xxx xxx xxxxxx xx which xxx xxxxxx learned of xxxx consequences (x.x., xxx date xx xxx xxxxxxx xxxxxx).

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

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx decision xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx discontinuation of xxxxxxxx prosecution, xxxx xx xxx indictment, xxxxxxxxx - final xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx xxxxxx of xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx depending xx xxxxxxx xxx xxxxxx xxx xxxx xxx xx xxx xxxxx xxxxxxxx xx xxxxxxx x xxxxx for xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx xxx xxxxx person responsible xxx xxx harm xxxxxxxx. Xx xxx xxxx in xxxx xxxx if xxx xxxxxxxx xxx not xxxx identified.

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Fill xx xxxx XxXx xx xxx applicant is x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx crime.

1. Xxx xxx a xxxxx, xxxxxx or xxxxx xx the xxxxxx who died xx xxxxxxxxxxx xx xxx xxxxxxxx offence?

2. Xxx xxx live xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xxxxxx xxxxx xx xxx commitment xx xxx xxxxx?

3. Xxxx xxx a xxxxxxxxx of xxx xxxxxx xx xxx xxx deceased xxxxxxx xx xxxxxxx xxx?

4. Xx any xxxxx xxxxxxx xxxx the xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 to 3? Xxxxxx give xxxxx xxxxxx, if xxxxx xx you.

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According xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, x xxxxxx who is x survivor of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx x criminal xxx xx considered xx xx a xxxxxx xx xx xx she xx x xxxxxx, spouse xx child xx xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx in xxx same household xx xx xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the applicant xx xxx xxxxxx xx x crime xxx has xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx items XX - XXX.

Please attach x xxxxx-xxxxx assessment xx pain xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx should xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx for xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx xx xxx xxx suffered xxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x social position. Xxxxxx xxxx in xxxx xxxx only xxx xxxxx-xxxxx assessment xx the pam xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act xx. 209/1997, no xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx the xxxxx assessment xx xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

The xxxxxx may xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx xx CZK 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx a xx Xxx Xx. 209/1997 Xxxx.). lf you xxxxxx to xxxxx xxx x xxxx xxx payment, xxxxx xx xx xxxx xx xxxx xx xxxxx XXX - XxX.

This xxxxxxxx xxx expenses xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., provided such xxxxx xxxx not xxxx paid xx xx xxxxxxxxx xxxxxxx. xx such xxxxxxxx xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx to xxx application.

If the xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx from his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Act xx. 262/2006, the Xxxxx Labour Code, xx amended. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. lf xxx xxxxxxxxx xx a xxxxxxx person xxx xx xxxx xx xxxxx his/her impaired xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx xxx xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx exceptional cases xx xxxxxxxxx may xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx act xx which X xxx x victim. X have xxx xxx xxxx compensated xxx the harm 1 xxxx xxxxxxxx xx a xxxxxx xx the xxxxxxxx xxx.

X xxxxxx affirm xxxx X xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxxx claim for xxxxxxxxxxxx for xxx xxxx xxxxxxxx as x result xx xxx xxxxxxxx xxx xx xxx xxxxxxx xxxxx than xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Xxxx., xx xxx provision xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx xx amending xxxxxxx xxxxx xxxx, xx xxxxxxx, I xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Justice xxx xxxxxx received xx xxxxxxxxxxxx xxx the xxxx xxxxxxxx, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx five xxxxx from xxx xxxx xx receiving xxx funding xxxxxxx. X also acknowledge xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx waive xxx xxxxx'x xxxxx for xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx standing, the xxxxx xxxxxx of xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx consciously xxxxxx xxxxx xx xxxxxxxxxx information xx xxxxxxxxxxx information xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent xx xxxxxxx pursuant to §21, xxxxxxx 1, xxxxxx x) of Xxx no. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx applicant xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx of xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx to Xxx No. 209/1997, xxx Xxxxxxxx of Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx assign xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall xxxxxxxx xx investigation xxxx xxx police xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx documents, xxx Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx inform xxx xxxxxxxxx xx xxx xxxxxxx xxx such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx considered x xxxxxx as xxx Xxx No. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx. X xxxxxxxxx xxx xxx xxx ohly xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx shall xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx position), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx a crime xxxxx xx considered xx be a xxxxxx if the xxxxxxxx xx a xxxxxx, spouse or xxxxx of the xxxxxxxx and the xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx or if xxx xxxxxxxx supported xx was xxxxxxxx xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxxxx xx xxxxxxxx xxxx stipulates x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx crime. If xxxx date does xxx xxxxxxxx xxxx xxx xxxx of xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx shall xxxxxxx xxxxxxxx of the xxxx on which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx anytime xxxxx the lapse xx xxx abovementioned xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied for xx a victim xxx xxx suffered xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx of x crime xxx xx in xxx xxxx xx x xxxx xxx amounting xx XXX 25,000 xx xx xxxxxx xxxxx to lost xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx as proved xx the victim, xxxxxxx by xxx xxxxxx xxxxxxxxxx xxxx xx the xxxxxx xx compensation for xxx xxxx xxxxxxxx. Xxx xxxxx amount xx such support xxxx not exceed XXX 150,000. If, xxxxx the xxxxxxxxx xx support, xxx xxxxxx proves that xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx from xxx xxxx xx which xxx xxxxxx xxxxxxx xx the harm xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx paid will xx taken xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx has xxxx as a xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx child xx xxx xxxxxxxx xxxxxx xx a xxxxxx household with xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xxxxxxxxx by or xxxxxxxx xx be xxxxxxxxx by xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx the xxxxxxxxx xxxxxxxxx of xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx liability insurance. Xx matters xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should thus xx directed xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx in isolated xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx application xxx xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxx with xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx be xxxxxxxx to xxx xxxxxxxxxxx. If xxx xxxxxxxxx fails to xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx deliver xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx fact may xxxxxxx x decision xx withhold xxx xxxxxxx xx per Xxx No. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, prejudice xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Please xxxx in mind xxxx the xxxxxxxxx xxxxx be xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx received xx xxxxxxxxxxxx for xxxx (xxxx xxx xxxxxxxx, insurers etc.) xx xxx xxxxxxx xx xxx Ministry xx Justice up xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. This obligation xxxx xxx xxxxx xx xx/xxx has xxx xxxxxxxx any xxxxxxxxxxxx. If so xxxxxxxxx xx xxx xxxxxx in an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx to xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx a xxxxxx xx xxxxxxxxx by xxx xxxxxx'x xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxx xxxx xxxxxxxx and xxx xxxxxx of xxxxxxxxxxxx paid xx xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Vás obťažovať xxxxxxxxxxxx xxxxxxxx. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx o xxxxxxxxxxx peňažnej xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx o žiadateľovi - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx na xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Telefón:

7. X-Xxxx:

8. Občianstvo:

II. Ak xxxxxxxľx xxxxxxxxx iná xxxxx (zástupca) na xxxxxxx zákonného zastúpenia (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) alebo xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx o xxxxxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Preto k xxxxxxxx priložte kópiu xxxxx moci (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, prosím, xx xxxxx x umretej xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx narodenia:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. V xxxx xxxxxx xxxx xxxxxxx xxxxx v xôxxxxxx xxxxxxxxx činu k xxxxx xxxxxxxľx (xxxx, xxxxx, osoba xxxxxx x xxxxxxxxx domácnosti):

Ak xx žiadateľ osobou xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, x xxxxxxxx sa xxxx priložiť kópia xxxxxxxx xxxxx x xxxxxxx, ktoré dokladajú xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx xxxx xxxxxxxxx ju vyživovať (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx sobášny xxxx a pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx na xxxxxxx xxxx; x takom xxxxxxx xxxxxxx xxxxxxx xxxxx Vášho účtu.

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

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x xx xx xxxx x xxxxx xxx xxôxxxxxxx dozvedela xx neskôr, xxxxxx xxxx a ako (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx vystavenia).

VI. Označte xxxxx xxxxx x xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx zastupitelstvo, xxx), xxxxx naposledy xxxxx xxxxxxx x xxxxxxxx čine. Xxxxxx xx spisovú značku, xxx ktorou prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx činného x xxxxxxxx konaní, ktoré xxxx xxxxxxxxx x xxx, x xxxx xxxxxx sa vec xxxxxxxx (xxxx. uznesenie x odložení trestného xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx nárok xx xxxxxxx škody xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Xx)., xxxxxxxx xxxxx sa xôxx xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, či xxxx využila všetky xxxxxxx xxxxxxxxxxx na xxxxxxxxxx xxxxxx xx xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, ktorá zodpovedá xx xxxxx. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, či xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 zákona x. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Vám xxxxx xxxxxxxxxxx xxxxx.

1. Boli xxx rodičom, manželom xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx trestného činu?

2. Xxxx xxx s xxxxxx trestného xxxx xxxx xxxxxxxxx xxxxxxxxx xxxx v xxxxxxxxx xxxxxxxxxx?

3. Xxxxxxxxxxx Xxx xxxx trestného xxxx xxxxxx, xx xxxx x xxxx xxxxxxx?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx podmienky 1 xx 3? Xxxxxx xxx počet, ak Xxx xx xxxxx.

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

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Body IX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx xxxx xx zdraví.

IX. Uveďte xxxxx, kedy xx xxxxxxxx liečenie, respektíve xxxx xx skončila xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť činí:

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

XI. Xxxxxx, xx xxxxxxx x poskytnutie xxxxxxxx xxxxxx xx výške xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx alebo xx xxxxxxxx xxxxx xxxxxx xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx poskytnúť xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x ušlému zárobku. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx xx výške xxxxxxxxx čiastky, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx o xxxxxxx xx xxxxx, zdravotnícke xxxôxxx, náklady xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na xxxxx x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, x xxx. xxx podmienkou, xx xxxxx náklady xxxxxxxxx pojsťovňa. Xx xxxxxxx náklady xx xxxxx xxxxxxx, xxxx xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx zreteľ.

XIII. Popište xxxxxxxxx xxxxxx žiadateľa xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx predpisov. Xx je xxxxxxxľ xxxxxx samostatne zárobkovo xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx xxxxxxxľ poberá xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx prípade xx xxxxx xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx dôchodku) a xxxx, odkedy ich xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx na xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x xxxxx nemocenských xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx na zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx mi xxxxx xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx vyhlasujem, že xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx som neuplatnil(a) x xxxxxxx inom xxxxx xxx x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, že xx xxxľx xxx. §12 xxxxxx x. 209/1997 Zb., o xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti x o zmene x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, keď mi xxxxxxxx xxxxx, odviesť xx xxxx Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) ako xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x tým xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx štátu xxxxxx práva xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx sociálna xxxxxxxx xxxx taký xxxxxx odôvodňovať, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili a xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx tiež xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx xxxx zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx č. 200/1990 Xx., x xxxxxxxxxxxx, x znení xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Ministerstvo spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Potom xxxx xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx mesiacov xx xxxxxx xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx nemožno xxxxxxxx.

- X zmysle zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx za xxxx xxx x xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx činu xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Nevyhnutnou, nie xxxx postačujúcou podmienkou xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx výška bodového xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx sa xxxxxxxx xx xxxxx xxxxxxxxx xx obeti, xxxxx x xôxxxxxx trestného xxxx zomrela, xx xxxx rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x zároveň x xxxx xxxx xxxxx x xxx žila x domácnosti, xxxxx xxxxx, xxxxxx zomretý xxxxxxxxxx alebo xxx xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx dňa, xxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx xx deň xxxxxxxxx trestného xxxx, xxxx xxxxxxxx okamžik, xxxx xx to xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie peňažnej xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx na žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, xxxxxxxx v xxxxxxxxx sume 25 000.- Xx alebo xx xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x súčet xxxxxxxx xxxxxxx, ktoré xxxx x titulu xxxxxxx škody xx xxxxxxx; xxxxx vo xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - xx xxx, xxx xxx poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx pomoci, xx xxx žiadosť x xxxxxx xxxxxxxxxx týmto xxxxxxx jej xxxxx xxxxxxxxx xxxxx opäť, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx na xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, ktorá je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela (xx xxxx xxxxxxx, xxxxxxxx alebo dieťaťom xxxxxxxxx a xxxxxxx x xxxx jeho xxxxx x xxx xxxx x domácnosti, xxxxx xxx zomretý xxxxxxxxxx, či bol xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne peňažná xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x xx je xxxxx obetí xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx každej xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx plnenia. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x potvrdenia, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx xxxxx xxx xxx poskytnutia xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx škody (od xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx povinnosť nemá, xx xx škodu xxxxxxxxxx. Xx základe xxxxxxxx obete sa xxxxxxxxxxxx spravodlivosti môže x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx vzdať xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.