Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Assessment xx Applications xxx xxx Provision xx Xxxxxxxxx Support xx Xxxxxxx of Criminal Xxxx pursuant to Xxx Xx. 209/1997 Xxxx., on the xxxxxxxxx of fulancial xxxxxxx to xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx certain xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx you with xxxxxxxx questions in xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx questionnaire xx xxxxxxxx for xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx for xxx provision xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx xxx xxx your xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

_____________________________________________________________________________________________

X. Please legibly xxxx xx xxx xxxxxxxx data xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who xxx xxxxxxxx xxxxxx harm, xx xxx xxxxxxxx xx x xxxxxx xxx has xxxx xx consequence of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given name:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx applicant xx represented xx xxxxxxx xxxxxx ("representative") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx parent) xx xx the xxxxx of a xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx of xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx registered address:

If xxx xxxxxxxxxxxxxx xx xxxxxx xxx application xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx submit a xxxxxxxx authorizing xxx/xxx xx represent the xxxxxxxxx - a xxxx xx a xxxxx xx attorney (xxx contractual representation) xx a xxxx xx xxx birth xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx equivalent document.

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

1. Xxxxxxx:

2. Given xxxx:

3. Date of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

If xxx xxxxxxxxx xx x survivor of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx attach x copy xx xxx death xxxxxxxxxxx xxx xxx documents xxxxxxx xxxx xxx xxxxxxxx supported or xxx xx obligation xx xxxxxxx the xxxxxxxx (in xxx xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx the xxxxxxxxx; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx attach a xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx crime was xxxxxxxxx xxx, xx xxx xxxxxx xxxxxxx xxxxx the xxxxxxxxxxxx xx xxx crime xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx xxx xxxx xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x office, court) xxxxx xxxx xxxxxxxx xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx xx xxx xxxx xxxxxxx to xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, please attach xxx latest xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx could xxxxxxxx xxx xxxxx of xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx xx xxxxxxxx prosecution, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx xxxxxxxxx).

Xxxxxxxxx xx xxx provisions xx §8 xx Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx may xx reduced or xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx made xxx xx all legal xxxxxxxx xx enforce x xxxxx for xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx any xxxxx xxxxxx responsible xxx xxx harm xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

______________________________________________________________________________________________

Xxxx xx xxxx VlIl if xxx applicant xx x xxxxxxxx of xx xxxxxxxxxx xxx xxx died in xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx xx xxx xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx offence?

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

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

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

______________________________________________________________________________________________

Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Act xx. 209/1997, a xxxxxx xxx is x survivor xx x xxxxxx xxx xxxx xx consequence xx x xxxxxxxx xxx xx considered xx xx x xxxxxx xx he xx xxx is x xxxxxx, spouse xx xxxxx of xxx xxxxxxxx and xxxxx xxxx xxx xx xxx xx xxx same xxxxxxxxx xx if xxx xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxx xxx required xx support xxx xxxxxx.

Xx xxx xxxxxxxxx xx xxx xxxxxx xx x xxxxx xxx xxx suffered xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx should be xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx xxx xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx contain a xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx a xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x xxxxxx position. Xxxxxx bear in xxxx xxxx only xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx is xxxxxxxx xxx xxx purposes xx Xxx xx. 209/1997. Xxxxxxxxx xx xxx provisions xx §6, section 2 xx Act no. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx xxxx xxxxxxxx xx xx xxxxx 100 points.

Xxx xxxxxx xxx xxxxxx xxxx sum xxxxxxxxx xxxxxxx in the xxxxxx of XXX 25,000 or xx xxxxxx equal xx xxx proved costs xx xxxxxxx xxxxxxxxx xxx xxxx income (§7, xxxxxxx 1, xxxxxx a xx Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx xx xxxxx xxx a xxxx xxx xxxxxxx, xxxxx xx xx need xx xxxx in xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx to xxxx xxx in xxx xxxx xx xxxx medical xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx xx xx insurance xxxxxxx. xx such xxxxxxxx xxx not proved xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx xxx not xxxx them xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx documents confirming xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Xxx xx. 262/2006, the Xxxxx Xxxxxx Xxxx, xx xxxxxxx. lf xxx applicant xx xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx of his/her xxxx xxxxxx xxx xxxxxx. lf xxx xxxxxxxxx is x xxxxxxx person xxx xx xxxx xx xxxxx xxx/xxx impaired xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx xxx amount xx xxx xxxxxxxxxx xxxxxxx. lf for xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx exceptional cases xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx has xxxx xxxxxxxx as x xxxxxx xx xxx criminal xxx xx which X xxx x victim. X xxxx not xxx xxxx xxxxxxxxxxx xxx the xxxx 1 have xxxxxxxx xx a xxxxxx xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx X xxxx xxx xxxxxx xxx xxxxx xxx financial xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx criminal act xx any xxxxxxx xxxxx xxxx the Xxxxx Republic.

I xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Xxx Xx. 209/1997 Xxxx., xx the provision xx xxxxxxxxx support xxx the victims xx xxxxxxxx acts xxx on xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, I xx xxxxxxx to xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx as xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx the xxxx xx xxxxxxxxx xxx funding xxxxxxx. X also acknowledge xxxx, xxxxx the xxxxx of xxx xxxx-xxxx xxxxxx, X xxx file xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx xxxxx the xxxxx'x claim for xxx xxxxxx xx xxx provided xxxxxxx, xxxxxx xxxx a xxxxxx xx well xxxxxxxx xx my xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx xxxxxxxx.

X also xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx for xxx purposes xx xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx c) of Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx xxxxxxx.

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

Xxxxxxxxx of xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx xx xxx xxxxxxxxxxx for xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Ministry of Xxxxxxx shall confirm xxxxxxx and assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx shall initiate xx xxxxxxxxxxxxx with xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx xxx the xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx months xxxx xxx xxxx xx xxx xxxxxxx xx xxx application xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has been xxxxxxxx.

- The xxxxxxxxx xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. xxxx xx he/she xxx xxxxxxxx xxxxxx harm xx x xxxxxx xx the xxxxxxxxxx xx a xxxxx. X xxxxxxxxx but xxx the xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx of xxx xxx suffercd (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx of x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x crime xxxxx xx xxxxxxxxxx xx xx x xxxxxx if the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx shared a xxxxxxxxx xxxx xxx xxxxxxxx at the xxxx of xxx/xxx xxxxx or if xxx xxxxxxxx supported xx was xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Act No. 209/1997 Xxxx. on xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx xx criminal xxxx xxxxxxxxxx x xxxxxxxxxx term xx 1 year xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx date of xxx commitment of xxx crime, the xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx consequences. The Xxxxxxxx of Justice xxxxxx meet an xxxxxxxxxxx xxx the xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx xxxxx xx the xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx support xx xxxxxxx xxx xx x victim xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx of xxx xxxxxxxxxx xx x xxxxx xxx xx in xxx xxxx xx x xxxx xxx xxxxxxxxx xx CZK 25,000 xx xx amount xxxxx xx xxxx xxxxxx or the xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx xx xxx xxxxxx previously paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx total amount xx xxxx support xxxx xxx xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx support, xxx xxxxxx proves xxxx xxx harm xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx amount of XXX 150,000 if xx/xxx applies for xx xxxxxx the xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim learned xx xxx xxxx xxxxxx by xxx xxxxx); xx xxxx xxxx, xxx amounts xxxxxxx paid xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx x xxxxxxxx xx x xxxxxx xxx xxx xxxx as x xxxxxx xx the xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx in x xxxxxx household xxxx xxx deceased xx xxx time xx xxx/xxx xxxxx xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx xxxx a xxxx xxx amounting xx CZK 150,000. Xxx total amount xxxxxxxx xx xxxxxxxxx xxxxxxx shall xxx xxxxxx CZK 450,000; xxxxxx the number xx xxxxxxx exceed xxxxx, xxx amount xxxxxxxx xxx victim xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx xxxxxxx xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx in xxxxxxxx xxxxx, in xxxx xx exceptional circumstances, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xx xxxxx with xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx available xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx the xxxxxxxxxx xxxxx must xx xxxxxxxx xx the xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx xx xx xx, the Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx applicant xxxx xx deliver xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx fact xxx xxxxxxx a decision xx withhold xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, prejudice xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx mind xxxx the xxxxxxxxx xxxxx be xxxxxxx xx return xxx xxxxxxxxx xxxxxx received xx xxxxxxxxxxxx for xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx account xx xxx Ministry xx Xxxxxxx xx xx xxx xxxxxx xx the xxxxxxx xxxxxxxx. Xxxx obligation xxxx not xxxxx xx he/she xxx xxx xxxxxxxx any xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx in an xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx the xxxxx'x xxxxx xx xxxxx xxx return of xxx financial support xxxxxxxx after xxx xxxxx of xxx xxxx-xxxx term, xxxxxxxx xxxx a xxxxxx xx justified xx xxx xxxxxx'x social xxxxxxxx, the total xxxxxx xx xxx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx paid to xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že x xxxxxxxx, x ktorej xx xxxxxxxxxx, sme xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, ktorú si xxxxx ceníme.

______________________________________________________________________________________________

I. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx osobe pozostalej xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx zastúpenia (xxxx. maloleté xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx dohody x plnej xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Xxxxx k xxxxxxxx priložte xxxxx xxxxx xxxx (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx rodného listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo xxx xxxxxxx xxxxxxx.

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

1. Priezvisko:

2. Xxxx:

3. Xxxxx narodenia:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X akom xxxxxx bola xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx xxxxxx x xxxxxxxxx domácnosti):

Ak xx žiadateľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx listu x xxxxxxx, ktoré xxxxxxxxx xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - dieťa xôxxx x xxxxx list xxxxx rozhodnutie xxxx x vyživovacej xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx bude sobášny xxxx x xxx.)

XX. Xxxxxx, či žiadate xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; x takom xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx dátum, xxxx xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x xx xx xxxx x xxxxx xxx spôsobenej dozvedela xx neskôr, uveďte xxxx x xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie o xxxxxxxx xxxx. Uveďte xx spisovú xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx v xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, x akom xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx trestného xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x žiadosti.

VII. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx využila xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx xx xxxxxxxľx alebo inej xxxxx, xxxxx zodpovedá xx škodu. Xxxxx xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, ak xx Xxx xxxxx xxxxxxxxxxx známe.

1. Xxxx xxx xxxxxxx, manželom xxxxx dieťaťom xxxxx, xxxxx zomrela x xôxxxxxx xxxxxxxxx xxxx?

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

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

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

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

______________________________________________________________________________________________

Body XX. xx XXX. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx ujma xx zdraví.

IX. Xxxxxx xxxxx, kedy sa xxxxxxxx liečenie, xxxxxxxxxx xxxx sa xxxxxxxx xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx ohodnotenia xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx lekársky xxxxxxx xxxx obsahovať xxxxxx xxxxxxxxxx vytrpenej xxxxxxx a xxxxxx xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx účely xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Xxxľx ustanovenia §7 odst. 1 xxxx. x) zákona x. 209/1997 Xx. xx žiadosť xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx zodpovedajúcej preukázaným xxxxxxxx na xxxxxxxx x ušlému xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x peňažnú xxxxx xx xxxxx xxxxxxxxx čiastky, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx pomoc x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx náklady xx dopravu, a xxx. pod podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx ne ministerstvo xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

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

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré xxxxxxxxxx xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx o potvrdenie xxxxxxxxxxxxľx o priemernom xxxxxxx podľa §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx je xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, takou listinou xxxx xxxxxxxxx opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx pomery xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx xx zdraví, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx nemocenských xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx xxxxxx xx také, xx xxxxxxxx xxxxx, xxxxxxx xxx bol(a) xxxxxx, xx moja xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx mi takto xxôxxxxx, dosiaľ nebola xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx odškodnenie xxxx xxôxxxxxxx trestným xxxxx som neuplatnil(a) x žiadnom inom xxxxx xxx v Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx xxxxxxx, xx xx xxxľx xxx. §12 xxxxxx x. 209/1997 Zb., o xxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx pomoc, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x tým xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, aby xx x xxxx štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx xxxxxxxx xxxxxxxx xxxx taký xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, ktorú xx spôsobili x xxxxx náhrady, xxxxx xxx xxxxxx(x).

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

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

xxxxxx žiadateľa alebo xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Potom bude xxxxxxxxxx xx polícii xx na inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx okolností xxxxxxx. Xx xxxxx xxxxxxxx xx xxxxxx žiadosti x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx alebo xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Za xxxx sa považuje xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného xxxx zomrela, xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx žila x xxxxxxxxxx, xxxxx xxxxx, xxxxxx zomretý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 xxxx xxx xxx, keď xx obeť dozvedela x škode spôsobenej xxxxxxxx činom. Xx xxxxx dňom xx xxx xx deň xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje okamžik, xxxx xx to xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx žiadostiam x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx xxxxxxx xxxxx, ktorej x xôxxxxxx trestného xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx vo xxxxx, ktorá predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, ktoré xxxx x xxxxxx xxxxxxx xxxxx xx xxxxxxx; xxxxx vo xxxxxx súčte nesmie xxxxxxxxxx sumu 150 000.- Xx. Xx xxxx - po tom, xxx jej xxxxxxxx xxxxx - preukáže, xx jej vzniknutá xxxxx xx xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx na xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, ktorá xx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela (xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx jeho xxxxx x ním xxxx v xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, či xxx xxxxxxx poskytovať xxxxxx), xx poskytne peňažná xxxxx v xxxxxxxxx xxxx 150 000.- Kč; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x xx xx xxxxx obetí xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx obeti xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať xxxxxxx, xxxxx spravuje poistenie xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx xxxxxxx. Len x xxxxxx ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx je možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx.

- Pripomíname, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx x xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx byť dôvodom xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx peňažná pomoc, xxxxxxxľ xx xx xxxxxxx rokov odo xxx xxxxxxxxxxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx dostal xxx xxxxxxx xxxxx (od xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx xxxx, xx mu xxxxx xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx môže x xxxx xxxxx xx uplynutí stanovenej xäxxxxxxx doby vzdať xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, x výška xxxxxxx, xxxxx obeť xxxxxxx.