Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxx xxxxxxx of criminal xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you with xxxxxxxx xxxxxxxxx xx xxxx current xxxxxxxxx. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx assessment xx xxxx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant xx Xxx xx. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Xxxxxx legibly xxxx in xxx xxxxxxxx xxxx xx xxx applicant - x.x. xxx victim xx xxx xxxxxxxx xxx who xxx xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x person xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx represented by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx the basis xx statutory xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx child represented xx xxx/xxx xxxxxx) xx on xxx xxxxx xx x xxxxx of attorney, xxxxxx fill in xxx xxxx of xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx representative xx xxxxxx xxx application xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx submit x xxxxxxxx authorizing xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx representation) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) or any xxxxx xxxxxxxxxx xxxxxxxx.

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

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx xxxxxxxxx xx x survivor xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx or xxx xx xxxxxxxxxx xx support the xxxxxxxx (in xxx xxxx of x xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx xx a xxxxx xxxxxxxx on xxx obligation xx xxxxxxx xxx dependent; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx on xxxxx xxx xxxxx was xxxxxxxxx xxx, if xxx xxxxxx learned xxxxx xxx consequences xx the xxxxx xx a xxxxx xxxx, xxxxxx also xxxxxxx xxx date xxx xxx xxxxxx xx xxxxx the xxxxxx learned of xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx proceedings. Xxxxx xxx reference xxxxxx xx xxx xxxx xxxxxxx xx xxx respective proceedings.

If xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx the xxxxxxxxxxxxxx xxxxxxxx justice authority xxxxx xxxxx indicate xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx of xxxxxxxx prosecution, copy xx xxx indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx made use xx xxx xxxxx xxxxxxxx xx enforce x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx any xxxxx person responsible xxx xxx xxxx xxxxxxxx. Do xxx xxxx in xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx if xxx applicant xx x survivor of xx individual who xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

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

2. Xxx you xxxx xx a common xxxxxxxxx xxxx the xxxxxxxx xxxxxx prior xx xxx xxxxxxxxxx xx xxx crime?

3. Xxxx you a xxxxxxxxx of xxx xxxxxx or xxx xxx xxxxxxxx xxxxxxx xx xxxxxxx you?

4. Xx xxx other xxxxxxx meet xxx xxxxxxxxxx described xx xxxxxxx 1 xx 3? Xxxxxx give xxxxx xxxxxx, xx xxxxx xx xxx.

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Xxxxxxxxx xx the xxxxxxxxxx xx §2, section 2 xx Xxx xx. 209/1997, a xxxxxx xxx is x survivor xx x xxxxxx who xxxx in xxxxxxxxxxx xx x criminal xxx is considered xx xx a xxxxxx xx he xx she xx x parent, xxxxxx xx xxxxx of xxx xxxxxxxx and xxxxx xxxx xxx xx xxx in xxx xxxx xxxxxxxxx xx xx xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx xx the xxxxxxxx xxx required xx xxxxxxx the xxxxxx.

Xx the xxxxxxxxx xx xxx xxxxxx xx x xxxxx xxx xxx suffered xxxxxx harm, xxxxxx xxxx in items XX - XXX.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x treatment. Xxxx medical xxxxxx xxxx contain x xxxxx-xxxxx assessment xx xxx xxx suffered xxx x point-based xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx in xxxx xxxx xxxx xxx point-based assessment xx xxx pam xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According xx xxx xxxxxxxxxx of §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx will xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain xxxxxxxx xx at xxxxx 100 points.

The xxxxxx xxx obtain xxxx xxx financial xxxxxxx xx xxx xxxxxx of CZK 25,000 xx an xxxxxx xxxxx xx xxx proved xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, section 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx to xxxxx xxx x xxxx xxx payment, there xx no need xx fill xx xxxxx XII - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx xx xxxx xxx in xxx xxxx or xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx xxxx xxxxx xxxx not xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx such xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx them into xxxxxxxxxxxxx.

Xxxxxx attach xxx documents xxxxxxxxxx xxxx facts to xxx xxxxxxxxxxx.

Xx the xxxxxxxxx is an xxxxxxxx, xxxxx documents xxxxx xxxxxxx a xxxxxxxxx xxxx xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx a xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx xx xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx x document xxxxxxxxxx xxx xxxxxx xx xxx retirement xxxxxxx. xx for xxx xxxxxx the xxxxxxxxx'x income xxxxxxxxx xxxxxx xx xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x xxxxxx xx xxx xxxxxxxx act xx xxxxx X xxx x xxxxxx. X xxxx not xxx been xxxxxxxxxxx xxx xxx xxxx 1 have xxxxxxxx xx x xxxxxx xx the criminal xxx.

X xxxxxx affirm xxxx I xxxx xxx lodged xxx xxxxx for xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx suffered xx x result of xxx xxxxxxxx xxx xx xxx xxxxxxx xxxxx xxxx the Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx to §12 xx Xxx Xx. 209/1997 Xxxx., xx xxx provision xx xxxxxxxxx xxxxxxx xxx the xxxxxxx xx xxxxxxxx xxxx xxx xx amending xxxxxxx other acts, xx xxxxxxx, X xx obliged xx xxxxxxxxx xxx Ministry xx Xxxxxxx any xxxxxx xxxxxxxx as xxxxxxxxxxxx for xxx xxxx suffered, xx xx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx, within xxxx xxxxx xxxx the xxxx xx receiving xxx xxxxxxx xxxxxxx. X also xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx xxx xxxx-xxxx xxxxxx, X xxx file xx xxxxxxxxxxx asking xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim for xxx return xx xxx provided xxxxxxx, xxxxxx xxxx a xxxxxx xx well xxxxxxxx xx xx xxxxxx xxxxxxxx, the xxxxx xxxxxx of xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx information or xxxxxxxxxxx xxxxxxxxxxx xxx xxx purposes of xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx amended.

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Signature of xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx xx xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Xxxxxxxx of Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx shall initiate xx xxxxxxxxxxxxx xxxx xxx xxxxxx xx x similar authority xx per xxx xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx xxxxxx from xxx xxxx xx xxx xxxxxxx of xxx application and xxxxxxxxxx xx the xxxxxxxxx xxxxxxxxx, the Xxxxxxxx xxxxx either xxxxxxx xxx xxxxxxx xx inform the xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx applicant xxxxx be xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. only xx xx/xxx xxx xxxxxxxx xxxxxx harm xx a xxxxxx xx the commitment xx x crime. X xxxxxxxxx but xxx the ohly xxxxxxxxx xxx xxx xxxxxx'x receipt of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx point-based xxxxxxxxxx of the xxx xxxxxxxx (xxx xxx weakening of xxxxxx position), which xxxx xx at xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx who has xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx be xxxxxxxxxx xx xx a xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx of the xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx his/her xxxxx or xx xxx xxxxxxxx xxxxxxxxx xx xxx required xx xxxxxxx xxx xxxxxxxx.

- Xxx No. 209/1997 Xxxx. xx xxx provision of xxxxxxxxx xxxxxxx to xxxxxxx xx criminal xxxx xxxxxxxxxx a xxxxxxxxxx xxxx of 1 xxxx from xxx xxxx xx xxxxx the victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx with xxx xxxx of xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx which xx/xxx learned of xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx the xxxxx xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx applied xxx xx x xxxxxx xxx xxx suffered xxxxxx xxxx xx x xxxxxx xx xxx commitment of x crime xxx xx xx xxx xxxx of x xxxx xxx amounting xx XXX 25,000 xx xx amount xxxxx xx xxxx xxxxxx or the xxxxx xx xxxxxxx xxxxxxxxx xx proved xx the xxxxxx, xxxxxxx xx xxx xxxxxx xxxxxxxxxx xxxx xx the xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx total xxxxxx xx such support xxxx not xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx receive additional xxxxxxx xx xx xxx amount xx XXX 150,000 if xx/xxx xxxxxxx for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx xxxx xxx xxxx xx which xxx xxxxxx xxxxxxx xx the harm xxxxxx xx the xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- Xx individual xxx is x xxxxxxxx of x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (x parent, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx in x xxxxxx household xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx death or xxxxxxxxx by or xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx with x xxxx sum xxxxxxxxx xx XXX 150,000. Xxx total xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx xxx number xx victims xxxxxx xxxxx, xxx xxxxxx xxxxxxxx xxx victim xxxxx xx reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx motor xxxxxxxx xxxxxxx to xxxxxxxxxx liability xxxxxxxxx. Xx xxxxxxx related xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx thus xx xxxxxxxx xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx exceptional xxxxxxxxxxxxx, xxx xx application xxx xxx provision xx xxxxxxxxx xxxxxxx xx xxxxx xxxx xxx Ministry of Xxxxxxx.

- Please xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx confirmations xxxxxxxx xxx the respective xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx fails to xx xx, the Xxxxxxxx of Justice xxxxxx properly process xxx application. Should xxx applicant fail xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx even xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx fact xxx xxxxxxx a xxxxxxxx xx withhold xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, however, prejudice xxx filing xx xxxxxxx xxxxxxxxxxx.

- Please xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx obliged xx xxxxxx any xxxxxxxxx amount received xx xxxxxxxxxxxx xxx xxxx (from xxx xxxxxxxx, xxxxxxxx etc.) xx xxx account xx the Xxxxxxxx xx Justice up xx xxx xxxxxx xx xxx support xxxxxxxx. Xxxx xxxxxxxxxx xxxx not apply xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx so xxxxxxxxx by the xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx return of xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x waiver xx justified by xxx victim's xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx to xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Vás obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx posúdenia Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - obeti xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

II. Xx xxxxxxxľx zastupuje xxx xxxxx (zástupca) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx rodičom) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx o xxxxxxxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx xxx osobu, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Preto x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx inú xxxxxxx xxxxxxx.

XXX. Ak xxxxxxxľ xxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela, xxxxxxx, xxxxxx, xx xxxxx o umretej xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. V akom xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx xxxxxx x spoločnej xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx vyživovala pozostalú xxxxx alebo xxxx xxxxxxxxx xx vyživovať (xx xxxxxx xxxxx - xxxxx xôxxx x rodný list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx povinnosti, xxx xxxxxxxx xxxxx xxxxxxxx xxxx sobášny xxxx a pod.)

IV. Xxxxxx, či žiadate xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx oznámte xxxxx Vášho xxxx.

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

Xxxxxx dátum xxxxxxxxx xxxxxxxxx činu x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx neskôr, xxxxxx xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý naposledy xxxxx xxxxxxx x xxxxxxxx xxxx. Uveďte xx xxxxxxx xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného v xxxxxxxx konaní, ktoré xxxx xxxxxxxxx o xxx, x xxxx xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), pripojte xx x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx ste xxxxxxxxx xxxxx na xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa ustanovenia §8 xxxxxx č. 209/1997 (Xx)., peňažitá xxxxx sa môže xxxxxx alebo sa xxxxxxxx s prihliadnutím xx xx, či xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx na xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx od xxxxxxxľx alebo xxxx xxxxx, ktorá xxxxxxxxx xx škodu. Xxxxx xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx žiadateľ xx xxxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

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

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

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

3. Xxxxxxxxxxx Xxx xxxx xxxxxxxxx činu xxxxxx, xx bola x xxxx xxxxxxx?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx podmienky 1 xx 3? Uveďte xxx xxxxx, xx Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx č. 209/1997 Xx. xx xx obeť xxxxxxxx xxxxx pozostalá po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx alebo osoba, xxxxxx nebohý poskytoval xxxxx bol povinný xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx trestného xxxx x bola xx spôsobená xxxx xx xxxxxx.

XX. Uveďte xxxxx, kedy xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx skončila xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx činí:

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

XI. Xxxxxx, xx žiadate x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx alebo xx xxxxxxxx xxxxx ušlého xxxxxxx x nákladov xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť obete xxxxx poskytnúť xxxxxxx xxxxx xx výške xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx zodpovedajúcej preukázaným xxxxxxxx xx xxxxxxxx x xxxxxx xxxxxxx. Xx xx rozhodnete xxxxxx x xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, pribranie cudzej xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, a xxx. xxx podmienkou, xx tieto xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, inak xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx a xx xxxxxx ujmy xx xxxxxx spôsobenej xxxxxxxx xxxxx.

X xxxxxxxx pripojte xxxxxxx, xxxxx potvrdzujú xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx podľa §351 x nasl. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx neskorších predpisov. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx listinou xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového priznania. Xx xxxxxxxľ poberá xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx x xxxxx starobného xôxxxxxx. X xxxxxxx, že x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx možné xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx vyhlásením.

XIV. Uveďte xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx dôchodku) x xxxx, odkedy xxx xxxxxxxľ xxxxxx, xx xxxxxxx po xxxxxx xxxx xx xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X prípade, xx x xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx trestným činom Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx jeho výšku.

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

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx na odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom xxxx xxxxx ako v Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx xxxxxxx, xx xx podľa ust. §12 xxxxxx x. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx zákonov, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, keď mi xxxxxxxx xxxxx, xxxxxxx xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx škody, x xx xx xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx s xxx xxxxxx na vedomie, xx xx uplynutí xxxxxxxxxx päťročnej xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x xxxx štátu xxxxxx práva na xxxxxxxx poskytnutej xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx odôvodňovať, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili x xxxxx xxxxxxx, ktorú xxx xxxxxx(x).

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

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx na polícii xx na xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx mesiacov xx xxxxxx žiadosti x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx dôvody, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx poškodenie xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx podmienkou xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx bodového xxxxxxxxxxx bolesti (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Xx xxxx xx považuje xx xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx zomretého x xxxxxxx x xxxx jeho smrti x xxx xxxx x domácnosti, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

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

- Pomoc xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx trestného xxxx xxxxxxx xxxxx na xxxxxx, poskytne v xxxxxxxxx sume 25 000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané náklady xxxxxxx s xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z xxxxxx xxxxxxx xxxxx už xxxxxxx; pomoc xx xxxxxx xxxxx xxxxxx xxxxxxxxxx sumu 150&xxxx;000.- Xx. Ak obeť - po xxx, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx xx xxxxxx xxx tá, ktorá xxxx podkladom na xxxxxxxxxxx xxxxxx, na xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx jej xxxxx xxxxxxxxx xxxxx opäť, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx po obeti, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela (xx bola rodičom, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x zároveň x xxxx xxxx xxxxx s xxx xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx poskytovať xxxxxx), xx poskytne peňažná xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x ak xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx vozidiel, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Len x xxxxxx xxxxxxxxxxx xxxxxxxxx x prihliadnutím xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx spravodlivosti x xxxxxxxxxxx peňažnej xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné doklady x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx xxxxxxxxxx xôxx byť xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx bude žiadateľovi xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ xx do xxxxxxx rokov xxx xxx xxxxxxxxxxx pomoci xxxxxxx na účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx ako xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx a xxx.) xx do xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx obete xx xxxxxxxxxxxx xxxxxxxxxxxxxx môže x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, a xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.