Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx No. 209/1997 Xxxx., on xxx xxxxxxxxx of fulancial xxxxxxx xx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx current xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx the xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx xx the xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who has xxxxxxxx bodily xxxx, xx xxx survivor xx a person xxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Phone Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the applicant xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx statutory xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx of x xxxxx of attorney, xxxxxx fill xx xxx data xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the application xx behalf xx xxx applicant, please xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx him/her xx represent xxx xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx contractual xxxxxxxxxxxxxx) xx x xxxx xx xxx birth xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) or any xxxxx equivalent xxxxxxxx.

XXX. Xx the xxxxxxxxx xx x xxxxxxxx xx a person xxx xxx xxxx xx consequenee xx xxx respective xxxxxxxx xxx, xxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx of xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx the xxxxxxxx xx the xxxxxxxxx (x.x. xxxxxx, xxxxxxxx, xx individual xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx xx x survivor xx x person xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx attach x copy of xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx supported or xxx xx obligation xx support the xxxxxxxx (xx xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, such xxxxxxxxx include birth xxxxxxxxxxxx or a xxxxx decision on xxx xxxxxxxxxx xx xxxxxxx xxx dependent; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx certificate).

Xxxxxx xxxxxxx the xxxx on xxxxx xxx crime xxx xxxxxxxxx xxx, if xxx xxxxxx xxxxxxx xxxxx the consequences xx xxx xxxxx xx a xxxxx xxxx, xxxxxx also xxxxxxx the xxxx xxx xxx manner xx xxxxx the xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx of xxx medical report).

VI. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx authority (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx the reference xxxxxx of xxx xxxx related xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx the xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, copy xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx provisions xx §8 xx Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx made use xx xxx xxxxx xxxxxxxx xx xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or xxx xxxxx person xxxxxxxxxxx xxx xxx harm xxxxxxxx. Xx xxx xxxx in this xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx if xxx applicant is x xxxxxxxx xx xx individual xxx xxx died in xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

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

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

3. Xxxx xxx x xxxxxxxxx of xxx xxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx support xxx?

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

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According xx the xxxxxxxxxx xx §2, section 2 xx Xxx xx. 209/1997, a xxxxxx xxx is x xxxxxxxx xx x victim xxx xxxx xx xxxxxxxxxxx xx x xxxxxxxx xxx xx considered xx xx a xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx child xx xxx xxxxxxxx xxx xxxxx with xxx xx xxx xx xxx same household xx xx the xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx or the xxxxxxxx was xxxxxxxx xx support the xxxxxx.

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

Xxxxxx attach x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x treatment. Xxxx xxxxxxx report xxxx contain x xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xxx a xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx only xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xx xxxxxxxx xxx xxx purposes xx Xxx no. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx xx xxx pain xxxxxxxx xx xx least 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxx xx XXX 25,000 or xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx lost income (§7, section 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx xxxxx xxx x xxxx xxx xxxxxxx, there xx xx xxxx xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx out in xxx home xx xxxx medical treatment, xxxxxxxxx transportation costs xxx., xxxxxxxx such xxxxx xxxx xxx xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx not proved xx xxxxxxxxxxx evidence, xxx Ministry of Xxxxxxx xxx not xxxx xxxx xxxx xxxxxxxxxxxxx.

Please attach xxx documents xxxxxxxxxx xxxx xxxxx to xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is xx xxxxxxxx, xxxxx documents xxxxx xxxxxxx x xxxxxxxxx from his/her xxxxxxxx describing xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Act xx. 262/2006, xxx Xxxxx Labour Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx document xxxxx be a xxxx of xxx/xxx xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx who xx xxxx to xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx x document xxxxxxxxxx the amount xx xxx xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x xxxxxx situation xxxxxx be proven, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x result xx xxx xxxxxxxx xxx xx xxxxx X xxx x xxxxxx. X have xxx xxx xxxx xxxxxxxxxxx xxx xxx harm 1 xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx xxxxxx any xxxxx xxx financial xxxxxxx xx xxx xxxxxxx xxxxx for xxxxxxxxxxxx xxx xxx xxxx suffered as x result xx xxx xxxxxxxx xxx xx any country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx according xx §12 of Xxx Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx support xxx xxx victims xx criminal xxxx xxx xx amending xxxxxxx other acts, xx amended, X xx xxxxxxx xx xxxxxxxxx the Ministry xx Justice any xxxxxx received xx xxxxxxxxxxxx xxx xxx xxxx suffered, up xx the xxxxxx xx the financial xxxxxxx, within five xxxxx from xxx xxxx of receiving xxx funding xxxxxxx. X xxxx xxxxxxxxxxx xxxx, after xxx xxxxx xx xxx xxxx-xxxx xxxxxx, I xxx xxxx an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx such x xxxxxx be well xxxxxxxx xx my xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx suffered xxx xxx xxxxxx of xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx consciously xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, section 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall initiate xx xxxxxxxxxxxxx xxxx xxx xxxxxx or x xxxxxxx xxxxxxxxx xx per xxx xxxxxxxx xxxxxxx xx xxx xxxx. Within xxxxx xxxxxx from xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx why xxxx xxxxxxx has xxxx xxxxxxxx.

- The xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. xxxx xx he/she xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx a crime. X xxxxxxxxx but xxx the xxxx xxxxxxxxx for xxx xxxxxx'x receipt of xxxxxxxx xxxxxxx xxxxx xx the xxxxxx xx xxx point-based xxxxxxxxxx xx xxx xxx suffercd (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx a xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx xxxxxx a xxxxxxxxx xxxx the xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx xxx xxxxxxxx xx support xxx xxxxxxxx.

- Act No. 209/1997 Xxxx. xx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx to xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx xxxx of 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx caused xx xxx xxxxx. Xx xxxx date xxxx xxx xxxxxxxx xxxx xxx date xx xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. The Xxxxxxxx of Justice xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx received anytime xxxxx the lapse xx xxx abovementioned xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx x victim xxx has xxxxxxxx xxxxxx xxxx as x result xx xxx commitment of x xxxxx may xx in xxx xxxx xx x xxxx sum amounting xx CZK 25,000 xx xx xxxxxx xxxxx xx lost xxxxxx or xxx xxxxx of medical xxxxxxxxx xx xxxxxx xx the victim, xxxxxxx xx any xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx compensation xxx xxx xxxx incurred. Xxx xxxxx amount xx xxxx support xxxx xxx exceed XXX 150,000. If, xxxxx xxx provision xx xxxxxxx, the xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, the victim xxx xxxxxxx additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx period of xxxx (i.e., 1 xxxx from xxx xxxx xx which xxx victim learned xx the xxxx xxxxxx xx xxx xxxxx); xx such xxxx, xxx xxxxxxx xxxxxxx paid xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx is a xxxxxxxx xx a xxxxxx who has xxxx as x xxxxxx xx the xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx or xxxxx xx xxx deceased xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx death xx xxxxxxxxx by xx xxxxxxxx xx xx xxxxxxxxx by xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx a xxxx sum xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx the number xx xxxxxxx exceed xxxxx, xxx xxxxxx xxxxxxxx per victim xxxxx be reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. does xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx of motor xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx accidents, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx xxxx xx directed to xxx insurers xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx in xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx the provision xx xxxxxxxxx xxxxxxx xx filed xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx xxxx xx mind xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx the xxxxxxxxxx xxxxx must xx xxxxxxxx to xxx xxxxxxxxxxx. If xxx xxxxxxxxx fails xx xx xx, xxx Xxxxxxxx xx Justice xxxxxx properly xxxxxxx xxx application. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx may xxxxxxx a decision xx xxxxxxxx any xxxxxxx as per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx in xxxx xxxx the xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx amount xxxxxxxx xx compensation for xxxx (xxxx xxx xxxxxxxx, insurers xxx.) xx xxx xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx the xxxxxx xx the support xxxxxxxx. This obligation xxxx not apply xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. If so xxxxxxxxx xx xxx xxxxxx in an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx xxxxxx xx xxx financial xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx justified by xxx xxxxxx'x social xxxxxxxx, the xxxxx xxxxxx of xxx xxxx xxxxxxxx and xxx amount of xxxxxxxxxxxx xxxx to xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, že x xxxxxxxx, x xxxxxx xx nachádzate, sme xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, xxxxxx spôsobili xxxx xx xxxxxx, xxxxx xxxxx pozostalej xx xxxxx, xxxxx x xôxxxxxx trestného xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) na xxxxxxx zákonného xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx rodičom) xxxxx xx základe xxxxxx x plnej xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Preto x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

XXX. Ak xxxxxxxľ xxxxx osoba xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela, xxxxxxx, prosím, aj xxxxx x xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx žiadateľa (otec, xxxxx, xxxxx žijúca x xxxxxxxxx xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, x žiadosti sa xxxx xxxxxxxx kópia xxxxxxxx listu x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx vyživovala xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu rodič - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx povinnosti, xxx manželov xxxxx xxxxxxxx xxxx sobášny xxxx a xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx xxxxxxx xxxx; x takom xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

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

Uveďte dátum xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx a ako (xxxxxxxxx z lekárskej xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx konaní (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx naposledy xxxxx konanie o xxxxxxxx xxxx. Uveďte xx xxxxxxx značku, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx o xxx, x xxxx xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx nárok xx xxxxxxx xxxxx od xxxxxxxľx alebo inej xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Zb)., xxxxxxxx xxxxx sa môže xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku xx xxxxxxx škody xx xxxxxxxľx xxxxx inej xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx trestného činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx xxxxxxxxx uvedené x §2 odst. 2 zákona x. 209/1997 Xx., prípadne xxľxx xxôx xxľxx xxxxx podmienky, xx xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx v xôxxxxxx xxxxxxxxx xxxx?

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

3. Xxxxxxxxxxx Xxx xxxx xxxxxxxxx xxxx xxxxxx, či xxxx x tomu povinná?

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

Podľa xxxxxxxxxxx §2 odst. 2 zákona x. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx povinný xxxxxxxxxx xxxxxx.

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Xxxx IX. xx XXX. Vyplňte, xx sa žiadateľ xxxx xxxxxx trestného xxxx a xxxx xx spôsobená xxxx xx xxxxxx.

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

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx obsahovať xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, že xxx xxxxx zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti. Podľa xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. nemožno xxxxxxxxx' peňažnú xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx žiadate x poskytnutie peňažnej xxxxxx vo výške xxxxxxxxx čiastky 25&xxxx;000.- Xx xxxxx xx xxxxxxxx výšku ušlého xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx ustanovenia §7 odst. 1 xxxx. a) xxxxxx x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx poskytnúť xxxxxxx xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx xxxxxxxx x ušlému xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x peňažnú xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx body XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie cudzej xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, x xxx. pod podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

XIII. Xxxxxxx xxxxxxxxx pomery xxxxxxxľx xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x xxxx. zákona x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x nejakého xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, odkedy xxx xxxxxxxľ poberá, xx xxxxxxx xx xxxxxx xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx priložte potvrdenie xxxxxxxxxxxxľx xxxxx xxxxxxxxx x výške nemocenských xxxxx. V xxxxxxx, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

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

Xxxxxx vyhlasujem, že xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx xx odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx som xxxxxxxxxx(x) x žiadnom xxxx xxxxx xxx x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx vedomie, xx xx xxxľx ust. §12 xxxxxx x. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx neskorších predpisov, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, ktoré xxx dostal(a) xxx xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx po xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x mene xxxxx xxxxxx práva xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja sociálna xxxxxxxx bude xxxx xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, xxxxx xx spôsobili a xxxxx xxxxxxx, ktorú xxx xxxxxx(x).

Xxxxxx tiež xx xxxxxxx, že xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného údaja xx xxxx zatajením xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, sa xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x priestupkoch, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx žiadateľa alebo xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx republiky po xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx na xxxxxxx xx na xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx potrebných xxxxxxxx xxx xxxxx xxxxxxxx alebo xxxxxxxľxxx xxxxxx dôvody, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx peňažnej xxxxxx xxxxx xxxxx xx výška xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Xx xxxx xx považuje xx xxxxx xxxxxxxxx xx obeti, ktorá x xôxxxxxx xxxxxxxxx xxxx zomrela, xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx jeho smrti x xxx žila x domácnosti, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo bol xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 roka xxx dňa, xxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx je xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje xxxxxxx, xxxx sa to xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, ktoré mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Pomoc xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx škoda na xxxxxx, poskytne x xxxxxxxxx sume 25&xxxx;000.- Xx xxxxx xx xxxxx, ktorá xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané náklady xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx xxx, xxx xxx poskytli xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx je xxxxxx xxx xx, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx stanovenej týmto xxxxxxx jej xxxxx xxxxxxxxx xxxxx opäť, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx na xxxxxxx, ktoré xx xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx po obeti, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx výživu), xx poskytne xxxxxxx xxxxx v xxxxxxxxx xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x ak je xxxxx obetí viac xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx vozidiel, xx xxxxx nadväzuje xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx je xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať subjekt, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx možné xxxxxx ministerstvo spravodlivosti x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, táto xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je xx xxxxxxx xxxxx xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx dostal xxx xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx x xxx.) až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx povinnosť xxxx, xx xx škodu xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, celková výška xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, ktorú xxxx xxxxxxx.