Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., on the xxxxxxxxx xx xxxxxxxxx xxxxxxx xx the xxxxxxx xx xxxxxxxx xxxx and on xxxxxxxx certain xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx questions xx xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who xxx xxxxxxxx xxxxxx harm, xx xxx xxxxxxxx xx x person xxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

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

6. Phone Xxxxxx:

7. X-xxxx address:

8. Xxxxxxxxxxx:

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

1. Surname:

2. Xxxxx name:

3. Xxxxxxxxx xx registered xxxxxxx:

Xx xxx representative is xxxxxx the xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx x xxxxx xx attorney (xxx xxxxxxxxxxx representation) xx a copy xx xxx xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx any xxxxx equivalent xxxxxxxx.

XXX. Xx xxx applicant xx x xxxxxxxx xx x person xxx xxx xxxx xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, xxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

If xxx xxxxxxxxx is x survivor of x xxxxxx xxx xxxx in xxxxxxxxxxx xx the criminal xxx, please attach x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx supported or xxx xx obligation xx support xxx xxxxxxxx (xx xxx xxxx xx a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx the xxxxxxxxx; xx the xxxx xx married xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx xx which xxx xxxxx was xxxxxxxxx and, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx the xxxxx xx x later xxxx, xxxxxx xxxx xxxxxxx xxx date xxx the xxxxxx xx xxxxx the xxxxxx learned xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx of xxx xxxxxxx report).

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

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice authority xxxxx could xxxxxxxx xxx xxxxx of xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 of Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx reduced xx xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx xxxx xxx xx all xxxxx xxxxxxxx to enforce x xxxxx xxx xxxxxxxxxxxx against xxx xxxxxxxx or any xxxxx xxxxxx xxxxxxxxxxx xxx the harm xxxxxxxx. Xx xxx xxxx xx this xxxx xx xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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Xxxx in xxxx VlIl xx xxx xxxxxxxxx is x xxxxxxxx xx xx xxxxxxxxxx who xxx died in xxxxxxxxxxx xx xxx xxxxxxxxx crime.

1. Xxx xxx x xxxxx, spouse xx xxxxx xx the xxxxxx who died xx consequence of xxx xxxxxxxx xxxxxxx?

2. Xxx xxx xxxx xx a xxxxxx xxxxxxxxx with xxx xxxxxxxx person xxxxx xx the xxxxxxxxxx xx xxx xxxxx?

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

4. Xx xxx xxxxx xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Please xxxx xxxxx xxxxxx, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 of Xxx xx. 209/1997, a xxxxxx who xx x xxxxxxxx of x victim xxx xxxx in xxxxxxxxxxx xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx x xxxxxx if xx xx she xx x xxxxxx, xxxxxx xx child xx xxx xxxxxxxx and xxxxx with xxx xx her xx xxx xxxx xxxxxxxxx xx if xxx xxxxxx xxx a xxxxxxxxx of xxx xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

Xx the xxxxxxxxx xx the xxxxxx xx a xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XXX.

Xxxxxx attach x xxxxx-xxxxx xxxxxxxxxx xx xxxx xxx xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx should xx xxxxxxxx xxxx the xxxxxxxxx responsible xxx xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx of xxx xxxxxxxx xx xxx xxxxxx'x social xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx xxxx xxx point-based assessment xx the xxx xxxxxxxx xx relevant xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx to xxx provisions xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx xx xxx xxxx suffered xx xx least 100 points.

Xxx xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx the xxxxxx of XXX 25,000 xx an xxxxxx equal xx xxx proved xxxxx xx medical xxxxxxxxx xxx xxxx xxxxxx (§7, section 1, xxxxxx a xx Xxx Xx. 209/1997 Xxxx.). lf xxx xxxxxx xx apply xxx x xxxx xxx payment, there xx no need xx fill in xxxxx XXX - XxX.

This xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx xxx in xxx xxxx or xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., provided xxxx xxxxx have not xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx xxxx his/her xxxxxxxx describing xxx xxxxxxx xxxxxx according xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Labour Xxxx, xx amended. lf xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx a xxxx xx his/her xxxx xxxxxx tax xxxxxx. lf xxx xxxxxxxxx xx a xxxxxxx xxxxxx xxx xx xxxx to xxxxx xxx/xxx impaired xxxxxx standing, please xxxxxx x xxxxxxxx xxxxxxxxxx xxx xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx reason the xxxxxxxxx'x income xxxxxxxxx xxxxxx be xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx has xxxx xxxxxxxx xx x result of xxx xxxxxxxx xxx xx which I xxx a victim. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx xxx harm 1 xxxx suffered xx a xxxxxx xx xxx xxxxxxxx xxx.

X hereby xxxxxx xxxx I xxxx xxx lodged xxx xxxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxxx claim xxx xxxxxxxxxxxx for xxx xxxx xxxxxxxx xx x result xx xxx xxxxxxxx act xx xxx country xxxxx than xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Xxx Xx. 209/1997 Coll., xx the provision xx financial support xxx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Ministry xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx xxx xxxxxx xx xxx financial xxxxxxx, within xxxx xxxxx xxxx the xxxx of xxxxxxxxx xxx xxxxxxx xxxxxxx. X also acknowledge xxxx, xxxxx the xxxxx of the xxxx-xxxx xxxxxx, X xxx file an xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx waive xxx xxxxx'x xxxxx xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx such a xxxxxx be well xxxxxxxx xx my xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx information xx xxxxxxxxxxx information xxx xxx purposes of xxxxxxxxxxxxx xxxxxxx benefits xxx represent an xxxxxxx xxxxxxxx xx §21, section 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx xx xxx applicant xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx to Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx investigation xxxx xxx police xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx months from xxx date of xxx xxxxxxx xx xxx application and xxxxxxxxxx xx xxx xxxxxxxxx documents, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx xxxxxxx xx inform the xxxxxxxxx of the xxxxxxx why such xxxxxxx has xxxx xxxxxxxx.

- Xxx applicant xxxxx be considered x xxxxxx as xxx Xxx No. 209/1997 Xxxx. xxxx xx he/she xxx xxxxxxxx bodily xxxx xx a xxxxxx xx xxx commitment xx x crime. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx xxx the xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of the xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx who has xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx considered xx be x xxxxxx xx the xxxxxxxx xx x xxxxxx, spouse or xxxxx xx the xxxxxxxx xxx xxx xxxxxxxx shared x xxxxxxxxx xxxx the xxxxxxxx xx xxx xxxx xx his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx No. 209/1997 Xxxx. xx xxx provision xx xxxxxxxxx support xx xxxxxxx xx criminal xxxx xxxxxxxxxx a xxxxxxxxxx xxxx xx 1 xxxx from xxx xxxx on xxxxx the xxxxxx xxxxxxx of the xxxx xxxxxx xx xxx xxxxx. If xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx xx xxx commitment of xxx crime, xxx xxxxxx xxxxx provide xxxxxxxx of xxx xxxx on xxxxx xx/xxx learned xx xxx consequences. Xxx Xxxxxxxx of Justice xxxxxx meet xx xxxxxxxxxxx for the xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx for xx a victim xxx has xxxxxxxx xxxxxx harm xx x result xx xxx commitment of x crime xxx xx xx xxx xxxx xx a xxxx xxx xxxxxxxxx xx XXX 25,000 xx xx amount xxxxx to lost xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx xx xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx harm incurred. Xxx total amount xx xxxx xxxxxxx xxxx not exceed XXX 150,000. Xx, xxxxx xxx provision xx support, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx receive additional xxxxxxx up xx xxx xxxxxx xx XXX 150,000 if xx/xxx applies xxx xx within xxx xxxxxxxxxxxxxx period xx xxxx (i.e., 1 xxxx xxxx the xxxx on xxxxx xxx xxxxxx xxxxxxx xx xxx harm xxxxxx by xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx paid xxxx xx xxxxx into xxxxxxx.

- Xx individual xxx xx x xxxxxxxx of x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx xxxxx xx xxx deceased xxxxxx xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx or xxxxxxxxx xx or xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx CZK 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx the xxxxxx xx victims exceed xxxxx, xxx xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. does xxx replace xxx xxxxxxxxx xx the xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx should xxxx xx directed to xxx xxxxxxxx providing xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, in xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx support xx xxxxx with xxx Ministry xx Xxxxxxx.

- Xxxxxx xxxx xx mind xxxx xxx available xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx must be xxxxxxxx to xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx to xx xx, the Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx deliver xxx xxxx documents xxx xxxxxxxxxxxxx even within x xxxxxxxxxxxxx xxxxxxxx, xxxx fact xxx xxxxxxx x xxxxxxxx xx xxxxxxxx any xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx the xxxxxxxxx xxxxx be obliged xx return xxx xxxxxxxxx amount xxxxxxxx xx compensation for xxxx (xxxx the xxxxxxxx, xxxxxxxx etc.) xx xxx account xx xxx Xxxxxxxx xx Justice xx xx xxx xxxxxx xx the xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx apply xx he/she xxx xxx received any xxxxxxxxxxxx. Xx xx xxxxxxxxx by xxx xxxxxx xx an xxxxxxxxxxx, the Ministry xx Justice xxx xxxxx xxx state's xxxxx to xxxxx xxx xxxxxx xx xxx financial xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx the xxxx-xxxx xxxx, xxxxxxxx xxxx x waiver xx xxxxxxxxx by xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx of the xxxx xxxxxxxx and xxx xxxxxx of xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx v xxxxxxxx, v ktorej xx xxxxxxxxxx, xxx xxxxxx Vás xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Prosím, xxxxxxx xxxxxxľxx xxxxxx xxxxx o xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx osobe pozostalej xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx xxxxxx (x xxxxxxx, že xx xxxx od adresy xxxxxxxx xxxxxxxx):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx zastupuje xxx xxxxx (xxxxxxxx) xx xxxxxxx zákonného xxxxxxxxxx (xxxx. maloleté xxxxx xxxxxx xxxxxxx) xxxxx xx základe dohody x xxxxx moci, xxxxxxx údaje x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx inú osobu, xxxx xx doložiť xxxxxxxxxx, ktorá zastúpenie xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx zastúpení) alebo xxxxx xxxxxxx xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

XXX. Ak xxxxxxxľ xxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, xxxxxxx, prosím, xx xxxxx o xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

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

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré dokladajú xxxxxxxxxx, že xxxxxx xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx xxxx xxxxxxxxx ju vyživovať (xx xxxxxx xxxxx - dieťa xôxxx x xxxxx list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx bude sobášny xxxx x xxx.)

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

V. Xxxxxx xxxxx, xxxx xx obeť xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x ak xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx x ako (xxxxxxxxx x xxxxxxxxx xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx x xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx naposledy xxxxx xxxxxxx x xxxxxxxx čine. Xxxxxx xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx o xxx, x xxxx xxxxxx sa vec xxxxxxxx (napr. uznesenie x xxxxxxxx trestného xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

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

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx s xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx inej xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx žiadateľ xx xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx xxôx spľňa xxxxx xxxxxxxxx, xx xx Vám xxxxx xxxxxxxxxxx známe.

1. Xxxx xxx xxxxxxx, manželom xxxxx xxxxxxxx osoby, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx činu?

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

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

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

Podľa xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Xx. xx xx xxxx považuje xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx xxxxxxxxx činu xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

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

XX. Xxxxxx xxxxx, xxxx sa xxxxxxxx liečenie, respektíve xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx sa musí xxxxxxxx bodové ohodnotenie xx bolesť podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx bude obsahovať xxxxxx hodnotenie xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Pripomíname, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 odst. 2 zákona č. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, či žiadate x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx čiastky 25 000.- Xx alebo xx xxxxxxxx výšku ušlého xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. a) xxxxxx x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx poskytnúť xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx vo xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx zárobku. Xx xx rozhodnete xxxxxx x xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady na xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx xx xxxxx x xxxxxxxxxx xx xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, a xxx. xxx xxxxxxxxxx, xx tieto xxxxxxx xxxxxxxxx pojsťovňa. Tu xxxxxxx náklady xx xxxxx xxxxxxx, inak xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

XIII. Popište xxxxxxxxx pomery žiadateľa xxxx x po xxxxxx ujmy xx xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx xxxxxxxľ je x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx neskorších predpisov. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx o xxxxx starobného dôchodku. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx prípade xx xxxxx nahradiť xxxxxxxxxx o xxxx xxxxxxx vyhlásením.

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

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx nemocenských xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx invalidný xôxxxxxx, xxxxxx x xxxxxxx jeho xxxxx.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx moja xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx mi xxxxx xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx na xxxxxxx xxxxx xx xxxxxxx xxxxx na odškodnenie xxxx spôsobenej xxxxxxxx xxxxx som neuplatnil(a) x xxxxxxx inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx xxxxxxx, xx xx xxxľx xxx. §12 zákona x. 209/1997 Xx., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx neskorších xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) ako xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, aby xx x mene štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx taký xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, ktorú xx spôsobili a xxxxx náhrady, xxxxx xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx xxxx xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx výhody, sa xôxxx xxxxxxxx priestupku xxxľx §21 odst. 1 písm. x) xxxxxx x. 200/1990 Xx., o priestupkoch, x xxxxx neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx žiadosti x xxxxxxxxxxx peňažnej pomoci xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Potom bude xxxxxxxxxx xx xxxxxxx xx na xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx podaní xxxxxxxx x xxxxxxxxxx potrebných xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx dôvody, prečo xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx xx x xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Nevyhnutnou, nie xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx výška bodového xxxxxxxxxxx xxxxxxx (nie xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx xx považuje xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx jeho smrti x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx alebo xxx xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 roka xxx xxx, xxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom xx xxx xx deň xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx vyhovieť xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx škoda xx xxxxxx, poskytne x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, ktoré xxxx x xxxxxx xxxxxxx škody xx xxxxxxx; xxxxx vo xxxxxx súčte nesmie xxxxxxxxxx sumu 150&xxxx;000.- Xx. Ak xxxx - xx xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx stanovenej týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, ktorá xx xxxxxxxxxx xx obeti, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx xxxxx x xxx xxxx x domácnosti, xxxxx jej zomretý xxxxxxxxxx, xx xxx xxxxxxx poskytovať xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Kč; xxxxx vo xxxxxx xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Xx, x xx xx xxxxx obetí xxxx xxx xxx osoby, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx xxxxxxxxxxxxx vykonávateľa xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx xx potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, o xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x prihliadnutím xx xxxxxxxxx xxxxxxxxx xxxxxxxxx je možné xxxxxx ministerstvo spravodlivosti x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, táto skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej pomoci xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx bude žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx poskytnutia pomoci xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx xxxxxx ako xxxxxxx xxxxx (od xxxxxxxľx, poisťovne x xxx.) xx do xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx xxxx, xx xx škodu xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti xôxx x mene xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto postup xxôxxxxxxx xxxxxxxx situácia xxxxx, celková výška xxxxx, ktorú jej xxôxxxxxx, x výška xxxxxxx, ktorú xxxx xxxxxxx.