Plné znění - 241/2006 Sb.

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

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx the xxxxx assessment of xxxx xxxxxxxxxxx xxx xxx provision of xxxxxxxxx xxxxxxx pursuant xx Xxx xx. 209/1997. Thank xxx xxx xxxx xxxxxxxxxxx; xx is highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx xxx xxxxxxxx data of xxx xxxxxxxxx - x.x. the victim xx the criminal xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx has died xx xxxxxxxxxxx of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx applicant xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, a xxxxx xxxxx xxxxxxxxxxx xx his/her xxxxxx) xx xx the xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx fill xx xxx data xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Permanent xx registered xxxxxxx:

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

XXX. Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx has xxxx xx consequenee xx xxx xxxxxxxxxx criminal xxx, xxxxxx xxxx xx the xxxxxxxx xxxx of the xxxxxxxx:

1. Xxxxxxx:

2. Given xxxx:

3. Date xx xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx xxxxxxxxx is x xxxxxxxx of x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, please xxxxxx x copy of xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx an obligation xx xxxxxxx xxx xxxxxxxx (in xxx xxxx xx x xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx decision on xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx married couples, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify the xxxx on xxxxx xxx xxxxx xxx xxxxxxxxx and, xx xxx xxxxxx xxxxxxx xxxxx the xxxxxxxxxxxx xx xxx crime xx a later xxxx, please xxxx xxxxxxx the xxxx xxx xxx manner xx xxxxx the xxxxxx xxxxxxx xx xxxx consequences (e.g., xxx xxxx xx xxx xxxxxxx xxxxxx).

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

Xx xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx of xxx respective proceedings (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, copy xx xxx indictment, xxxxxxxxx - xxxxx xx otherwise).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx made use xx all xxxxx xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx xxx xxxxx xxxxxx responsible xxx xxx xxxx xxxxxxxx. Do not xxxx xx xxxx xxxx if xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx of xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxxxxxx?

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

3. Xxxx xxx a xxxxxxxxx xx xxx xxxxxx or was xxx xxxxxxxx xxxxxxx xx support xxx?

4. Xx any other xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 to 3? Please give xxxxx number, xx xxxxx to xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx xx x victim xxx xxxx in xxxxxxxxxxx xx x xxxxxxxx xxx xx considered xx be x xxxxxx xx xx xx xxx is x parent, xxxxxx xx xxxxx of xxx deceased xxx xxxxx xxxx xxx xx xxx in xxx same xxxxxxxxx xx xx xxx xxxxxx was x xxxxxxxxx xx xxx xxxxxxxx or xxx xxxxxxxx was required xx xxxxxxx xxx xxxxxx.

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

Please xxxxxx x point-based assessment xx pain xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx xx xxxxxxxx from xxx xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx contain a xxxxx-xxxxx xxxxxxxxxx of xxx pam xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx of xxx xxxxxxxx of the xxxxxx'x social xxxxxxxx. Xxxxxx bear xx xxxx xxxx xxxx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx is relevant xxx xxx xxxxxxxx xx Xxx no. 209/1997. According to xxx provisions of §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx of xxx pain xxxxxxxx xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx costs xx medical treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx a xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx x xxxx xxx payment, xxxxx xx no xxxx xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx assistant to xxxx xxx xx xxx home or xxxx xxxxxxx treatment, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx such xxxxx xxxx not xxxx paid by xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx attach xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx application.

If the xxxxxxxxx xx an xxxxxxxx, xxxxx documents xxxxx include 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 amended. lf xxx applicant xx xxxx-xxxxxxxx, such document xxxxx be x xxxx xx xxx/xxx xxxx recent xxx xxxxxx. lf xxx xxxxxxxxx is x xxxxxxx person who xx xxxx to xxxxx xxx/xxx impaired xxxxxx xxxxxxxx, please xxxxxx a xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx retirement xxxxxxx. lf xxx xxx reason xxx xxxxxxxxx'x xxxxxx situation xxxxxx xx proven, xx exceptional xxxxx xx affidavit xxx xx attached.

My xxxxxx xxxxxxxx xxx xxxx impaired as x xxxxxx xx xxx criminal xxx xx which X xxx a xxxxxx. X have xxx xxx xxxx compensated xxx the xxxx 1 xxxx xxxxxxxx xx a result xx the xxxxxxxx xxx.

X hereby affirm xxxx I xxxx xxx xxxxxx xxx xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx xxxxx for xxxxxxxxxxxx for the xxxx xxxxxxxx as x xxxxxx of xxx criminal act xx xxx xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx to §12 xx Xxx Xx. 209/1997 Xxxx., xx xxx provision xx financial xxxxxxx xxx the xxxxxxx xx criminal xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Justice xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx the xxxx xxxxxxxx, up xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, within five xxxxx xxxx the xxxx xx xxxxxxxxx xxx xxxxxxx support. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx xxxxxx, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x xxxxx xxx xxx xxxxxx of xxx provided support, xxxxxx such x xxxxxx xx well xxxxxxxx xx my xxxxxx standing, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount of xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx information xxx xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., on xxxxxxxx xx amended.

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Signature xx xxx applicant xx xxx/xxx representative

- Upon xxxxxxx of xxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx to Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx assign xx x serial xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx with xxx xxxxxx or x xxxxxxx authority xx per the xxxxxxxx details xx xxx xxxx. Xxxxxx xxxxx months from xxx xxxx of xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, the Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx support xx xxxxxx xxx xxxxxxxxx of the xxxxxxx xxx such xxxxxxx xxx been xxxxxxxx.

- The xxxxxxxxx xxxxx be considered x victim as xxx Xxx Xx. 209/1997 Xxxx. only xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx the xxxxxxxxxx xx x xxxxx. X xxxxxxxxx but xxx xxx ohly xxxxxxxxx for the xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx xxx amount xx xxx xxxxx-xxxxx xxxxxxxxxx of the xxx xxxxxxxx (xxx xxx xxxxxxxxx of xxxxxx position), xxxxx xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx has xxxx in xxxxxxxxxxx xx a crime xxxxx xx xxxxxxxxxx xx xx a xxxxxx xx the xxxxxxxx is x xxxxxx, xxxxxx xx xxxxx of the xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx or if xxx deceased supported xx was xxxxxxxx xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx provision xx xxxxxxxxx support xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx a xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx the xxxx xxxxxx by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx with xxx date of xxx commitment xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx meet xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Financial support xx xxxxxxx for xx x xxxxxx xxx has suffered xxxxxx xxxx as x xxxxxx xx xxx commitment xx x crime may xx xx xxx xxxx xx x xxxx xxx amounting xx XXX 25,000 xx xx amount xxxxx to xxxx xxxxxx xx xxx xxxxx of xxxxxxx xxxxxxxxx xx xxxxxx xx the victim, xxxxxxx by xxx xxxxxx previously xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx amount xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. If, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx proves xxxx xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx victim xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx amount of XXX 150,000 xx xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx of xxxx (i.e., 1 xxxx from the xxxx on which xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); in such xxxx, any xxxxxxx xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- An individual xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx xx the xxxxxxxxxx xx x xxxxx (x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xx xxx time of xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx by xxx xxxxxxxx) xxxxx xx xxxxxxxx with x xxxx xxx amounting xx XXX 150,000. Xxx total amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx xxx xxxxxx xx victims xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx the xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx thus xx xxxxxxxx xx xxx insurers providing xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxx with xxx Ministry of Xxxxxxx.

- Xxxxxx xxxx xx mind xxxx xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx respective xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. If the xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx fail xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx xxxx xxxxxx x supplementary xxxxxxxx, xxxx xxxx may xxxxxxx x decision xx xxxxxxxx xxx xxxxxxx as per Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx of xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx mind xxxx the applicant xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx received xx xxxxxxxxxxxx xxx xxxx (xxxx the xxxxxxxx, insurers xxx.) xx the xxxxxxx xx xxx Xxxxxxxx xx Justice xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx the xxxxxx in xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx xx claim xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx after the xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx a xxxxxx xx justified by xxx xxxxxx'x social xxxxxxxx, the xxxxx xxxxxx xx the xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx paid xx xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, v ktorej xx nachádzate, xxx xxxxxx Vás xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti xxxľx zákona č. 209/1997 Zb., xx však xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Vám za xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx osobné xxxxx o xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Priezvisko:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (zástupca) na xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx moci, xxxxxxx údaje o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx inú xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, ktorá zastúpenie xxxxxxx. Preto x xxxxxxxx priložte xxxxx xxxxx moci (xxx xxxxxxxx zastúpení) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela, xxxxxxx, xxxxxx, aj xxxxx x xxxxxxx xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx k xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x spoločnej xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela, x xxxxxxxx sa xxxx priložiť kópia xxxxxxxx listu x xxxxxxx, xxxxx dokladajú xxxxxxxxxx, že xxxxxx xxxxx vyživovala pozostalú xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

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

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

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

XX. Označte xxxxx xxxxx x xxxxxxxx konaní (policajný xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx čine. Uveďte xx xxxxxxx xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx posledné rozhodnutie xxxxxx činného v xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (napr. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

VII. Xxxxxx, xxxx spôsobom xxx xxxxxxxxx nárok xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa ustanovenia §8 xxxxxx x. 209/1997 (Xx)., peňažitá xxxxx xx xôxx xxxxxx alebo xx xxxxxxxx s xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx xxxxxxxxxxx, ak xxxxxxxľx trestného činu xxxxxxxxx.

Xxx XXXX. Vyplňte, xx xxxxxxxľ xx xxxxxxxxxx po osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, či xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 xxxxxx x. 209/1997 Xx., prípadne xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Boli xxx xxxxxxx, manželom xxxxx dieťaťom xxxxx, xxxxx xxxxxxx x xôxxxxxx trestného xxxx?

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

3. Xxxxxxxxxxx Vám xxxx xxxxxxxxx xxxx xxxxxx, xx xxxx x tomu povinná?

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

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx č. 209/1997 Zb. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx je xxxxxxx, manželom alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx smrti s xxx xxxx x xxxxxxxxxx xxxxx osoba, xxxxxx nebohý poskytoval xxxxx xxx povinný xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx spôsobená xxxx xx zdraví.

IX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx sa xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť činí:

K xxxxxxxx sa xxxx xxxxxxxx bodové ohodnotenie xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ získa xx xxxxxx, ktorý ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx hodnotenie xxxxxxxxx xxxxxxx a bodové xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Pripomíname, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx ohodnotenie xxxxxxxxx bolesti. Podľa xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 bodov.

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

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

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, zdravotnícke xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx xx pomoc x domácnosti či xxxxxxxxxx, xxxxxxx náklady xx dopravu, x xxx. xxx xxxxxxxxxx, xx tieto xxxxxxx xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx sa xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx neskorších xxxxxxxxx. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx x xxxxx starobného xôxxxxxx. X xxxxxxx, že x xxxxxxxx xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx prípade xx xxxxx nahradiť xxxxxxxxxx x nich xxxxxxx vyhlásením.

XIV. Uveďte xxxxx nemocenských dávok (xxxxxxxxxxx xôxxxxxx) a xxxx, odkedy xxx xxxxxxxľ xxxxxx, xx xxxxxxx po xxxxxx xxxx na xxxxxx, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo poisťovne x xxxxx nemocenských xxxxx. X prípade, xx x dôsledku xxxxx xx zdraví xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx jeho výšku.

Xxxx xxxxxxxxx xxxxxx xx také, xx xxxxxxxx činom, xxxxxxx xxx bol(a) xxxxxx, xx moja sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx takto xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx peňažnú xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx neuplatnil(a) x žiadnom inom xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx vedomie, že xx podľa ust. §12 zákona x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx zákonov, v xxxxx neskorších xxxxxxxxx, xxxxxx povinnosť xx xxxxxxx xxxxx xxx xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x tým xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, xxx xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, ktorú xx xxôxxxxxx a xxxxx xxxxxxx, ktorú xxx xxxxxx(x).

Xxxxxx tiež xx vedomie, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx xxxxx xx xxxx zatajením xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., o priestupkoch, x znení xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Ministerstvo spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx pomoci xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx príjem x udelí xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx xx polícii xx xx xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx okolností prípadu. Xx xxxxx xxxxxxxx xx xxxxxx žiadosti x predložení potrebných xxxxxxxx buď pomoc xxxxxxxx xxxxx žiadateľovi xxxxxx dôvody, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx mu v xôxxxxxx trestného činu xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx podmienkou xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (nie xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Xx xxxx xx považuje xx xxxxx pozostalá xx xxxxx, xxxxx x dôsledku trestného xxxx zomrela, ak xxxx rodičom, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx smrti x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx činom. Ak xxxxx xxxx už xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje okamžik, xxxx xx xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx vyhovieť xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx uplynutí xxxxxxxxxx lehoty.

- Xxxxx xx xx xxxxxxx xxxxx, ktorej v xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx xx xxxxxx, xxxxxxxx x xxxxxxxxx sume 25&xxxx;000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu na xxxxxxx, preukázané xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx tom, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx je xxxxxx xxx xx, ktorá xxxx podkladom xx xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx obeti, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx bola xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň x čase xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx výživu), xx poskytne xxxxxxx xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx obeti xxxxxxxxx kráti.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx vozidiel, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx ojedinelých xxxxxxxxx s prihliadnutím xx xxxxxxxxx výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Pripomíname, že xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, na xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx potvrdenia x xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však nevylučuje xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je xx xxxxxxx xxxxx odo xxx xxxxxxxxxxx xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (od xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx poskytnutej xxxxxx. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Na základe xxxxxxxx obete sa xxxxxxxxxxxx spravodlivosti xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby vzdať xxxxx xx vrátenie xxxxxxxxxxx xxxxxxxx pomoci. Xx xxxxxx postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, ktorú xxx xxôxxxxxx, a xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.