Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Assessment xx Applications xxx xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., on xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx xxx xxxx xxxxxxxx questions xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx for xxx xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx for xxx provision xx xxxxxxxxx xxxxxxx pursuant xx Xxx no. 209/1997. Xxxxx you xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx the xxxxxxxx xxxx xx xxx applicant - x.x. the victim xx xxx xxxxxxxx xxx who has xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Phone Number:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx instance, x xxxxx xxxxx represented xx xxx/xxx xxxxxx) xx on xxx xxxxx of x xxxxx xx xxxxxxxx, xxxxxx xxxx in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the application xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx authorizing xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of x xxxxx xx xxxxxxxx (xxx contractual xxxxxxxxxxxxxx) xx x xxxx xx the xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx the applicant xx x xxxxxxxx xx a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxxx xxxxxxxx xxx, please xxxx xx xxx personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date of xxxxx:

4. Xxxx of xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx xxx applicant (x.x. xxxxxx, xxxxxxxx, xx individual xxxxxx xx common xxxxxxxxx)

Xx xxx xxxxxxxxx is x xxxxxxxx of x person xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx any xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx supported xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx the xxxx xx a xxxxxx-xxxxx relationship, such xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx case xx xxxxxxx couples, xxxxxx attach x xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify the xxxx on xxxxx xxx xxxxx xxx xxxxxxxxx xxx, if xxx xxxxxx learned xxxxx xxx xxxxxxxxxxxx xx the xxxxx xx x later xxxx, please also xxxxxxx the xxxx xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (e.g., xxx xxxx xx xxx xxxxxxx report).

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

If xxxxxxxxx, please attach xxx xxxxxx xxxxxxxx xx the abovementioned xxxxxxxx justice xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx of xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, xxxx xx the indictment, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 of Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx depending xx xxxxxxx xxx victim xxx xxxx use xx all legal xxxxxxxx xx enforce x xxxxx for xxxxxxxxxxxx against xxx xxxxxxxx xx any xxxxx person responsible xxx the xxxx xxxxxxxx. Do xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx xxxxxxxxx xx x survivor xx xx individual xxx xxx died in xxxxxxxxxxx xx the xxxxxxxxx xxxxx.

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

2. Xxx xxx xxxx xx x common xxxxxxxxx xxxx xxx xxxxxxxx person xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

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

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

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Xxxxxxxxx xx xxx provisions xx §2, xxxxxxx 2 of Xxx xx. 209/1997, a xxxxxx xxx xx x xxxxxxxx of x victim xxx xxxx xx consequence xx x xxxxxxxx xxx xx xxxxxxxxxx xx be a xxxxxx xx xx xx she xx x xxxxxx, spouse xx child of xxx xxxxxxxx and xxxxx xxxx him xx her in xxx same xxxxxxxxx xx if the xxxxxx xxx x xxxxxxxxx of the xxxxxxxx xx the xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

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

Please attach x xxxxx-xxxxx xxxxxxxxxx xx pain xxx xxxxxxxxx xxxxxxxx to Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx xx xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx for xxx victim's xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx contain x xxxxx-xxxxx assessment of xxx pam xxxxxxxx xxx x point-based xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x social xxxxxxxx. Xxxxxx bear xx xxxx xxxx xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx provisions xx §6, xxxxxxx 2 xx Act xx. 209/1997, no xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain xxxxxxxx xx xx xxxxx 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx xx CZK 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, section 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx xx apply xxx x xxxx xxx payment, xxxxx xx xx need xx fill in xxxxx XII - XxX.

This xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx assistant xx xxxx out in xxx home or xxxx medical treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., provided xxxx xxxxx have xxx xxxx paid xx xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx evidence, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx them into xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. of Act xx. 262/2006, the Xxxxx Xxxxxx Code, xx xxxxxxx. lf xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx a xxxx of xxx/xxx xxxx recent xxx xxxxxx. lf the xxxxxxxxx is a xxxxxxx xxxxxx who xx able to xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx xxx amount xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx reason xxx xxxxxxxxx'x income situation xxxxxx be proven, xx exceptional cases xx xxxxxxxxx may xx xxxxxxxx.

Xx xxxxxx standing xxx xxxx xxxxxxxx xx x result xx xxx criminal xxx xx xxxxx X xxx x xxxxxx. X have xxx xxx xxxx xxxxxxxxxxx xxx xxx harm 1 have suffered xx x xxxxxx xx xxx criminal xxx.

X xxxxxx affirm xxxx X xxxx xxx lodged any xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx for the xxxx xxxxxxxx xx x result xx xxx criminal xxx xx xxx country xxxxx than the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according xx §12 xx Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx criminal xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx obliged xx xxxxxxxxx xxx Ministry xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx the xxxx suffered, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx five xxxxx xxxx xxx xxxx of xxxxxxxxx xxx xxxxxxx xxxxxxx. X also acknowledge xxxx, after xxx xxxxx xx xxx xxxx-xxxx period, X xxx xxxx xx xxxxxxxxxxx asking xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx be xxxx xxxxxxxx by xx xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx that xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx purposes xx xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx of xxx xxxxxxxxx xx xxx/xxx representative

- Xxxx xxxxxxx of xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant to Xxx Xx. 209/1997, xxx Ministry xx Xxxxxxx shall confirm xxxxxxx xxx xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police xx x similar xxxxxxxxx xx xxx the xxxxxxxx xxxxxxx of xxx case. Xxxxxx xxxxx xxxxxx from xxx date of xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx the xxxxxxxxx documents, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx xxxxxxx xx inform xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx be xxxxxxxxxx x xxxxxx as xxx Xxx No. 209/1997 Coll. only xx he/she xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x crime. X xxxxxxxxx but xxx the ohly xxxxxxxxx for xxx xxxxxx'x receipt xx xxxxxxxx xxxxxxx xxxxx xx the amount xx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx (xxx xxx xxxxxxxxx of xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx who xxx xxxx in consequence xx x xxxxx xxxxx be xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx is a xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx or xx xxx deceased supported xx was xxxxxxxx xx support xxx xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx support to xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 xxxx from xxx xxxx on xxxxx the xxxxxx xxxxxxx xx xxx xxxx caused by xxx xxxxx. Xx xxxx date does xxx xxxxxxxx with xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx shall xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx learned xx xxx consequences. Xxx Xxxxxxxx of Xxxxxxx xxxxxx meet xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx the xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx a xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx as x result xx xxx xxxxxxxxxx of x crime xxx xx xx xxx xxxx of x xxxx sum xxxxxxxxx xx XXX 25,000 xx an xxxxxx xxxxx xx xxxx xxxxxx or xxx xxxxx xx medical xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx by any xxxxxx xxxxxxxxxx paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx incurred. Xxx total xxxxxx xx such xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx to xxx xxxxxx xx XXX 150,000 xx xx/xxx applies for xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx xxxx xxx xxxx xx which xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx the xxxxx); in xxxx xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- Xx individual xxx xx a xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx be xxxxxxxxx xx xxx xxxxxxxx) shall be xxxxxxxx with x xxxx sum amounting xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx the xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx be xxxxxxx xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. does xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx to xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx matters xxxxxxx xx traffic accidents, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxx providing xxxx liability insurance. Xxxx in isolated xxxxx, in view xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx an xxxxxxxxxxx xxx the provision xx xxxxxxxxx xxxxxxx xx xxxxx with xxx Ministry of Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx documents xxx confirmations required xxx xxx xxxxxxxxxx xxxxx must xx xxxxxxxx to xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx to xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant xxxx xx xxxxxxx xxx xxxx documents and xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx deadline, xxxx xxxx may xxxxxxx a decision xx xxxxxxxx xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx of xxxxxxx application.

- Xxxxxx xxxx in xxxx xxxx the applicant xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx the account xx xxx Ministry xx Xxxxxxx xx xx the xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx xxx xxx received xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx the xxxxxx in xx xxxxxxxxxxx, the Xxxxxxxx xx Justice xxx xxxxx xxx state's xxxxx to claim xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx a waiver xx justified by xxx xxxxxx'x xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx the xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxxx paid xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, že v xxxxxxxx, v xxxxxx xx nachádzate, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. V xxxxxx xxxxxxxx posúdenia Xxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx k xxxxxxxx priložte xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) alebo xxxxx rodného xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Ak xxxxxxxľ alebo xxxxx xxxxxxxxx xx osobe, xxxxx v dôsledku xxxxxxxxx činu zomrela, xxxxxxx, xxxxxx, xx xxxxx x xxxxxxx xxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. V xxxx xxxxxx xxxx xxxxxxx xxxxx v xôxxxxxx xxxxxxxxx xxxx x xxxxx žiadateľa (otec, xxxxx, osoba xxxxxx x spoločnej domácnosti):

Ak xx xxxxxxxľ osobou xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx činu xxxxxxx, x xxxxxxxx xx xxxx priložiť kópia xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx vyživovať (xx vzťahu xxxxx - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx takou xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx na xxxxxxx xxxx; x takom xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx dátum xxxxxxxxx xxxxxxxxx činu x ak xx xxxx o škode xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx a xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - dátum xxx xxxxxxxxxx).

XX. Označte xxxxx činný x xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie o xxxxxxxx xxxx. Xxxxxx xx xxxxxxx značku, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (napr. xxxxxxxxx x odložení trestného xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx nárok xx xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx s prihliadnutím xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx osobou, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx osôb spľňa xxxxx podmienky, ak xx Vám xxxxx xxxxxxxxxxx xxxxx.

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

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

3. Xxxxxxxxxxx Vám xxxx trestného xxxx xxxxxx, xx xxxx x xxxx povinná?

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

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx zomretého x xxxxxxx v xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx alebo xxxxx, xxxxxx xxxxxx poskytoval xxxxx xxx povinný xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx x xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx 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 xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx hodnotenie xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx bolesti. Podľa xxxxxxxxxxx §6 odst. 2 zákona x. 209/1997 Xx. xxxxxxx xxxxxxxxx' peňažnú pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 bodov.

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

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

XII. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, zdravotnícke xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx pomoc x domácnosti či xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, a xxx. pod podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx náklady xx xxxxx xxxxxxx, xxxx xx xx ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx pomery žiadateľa xxxx x xx xxxxxx xxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti pripojte xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V prípade, xx žiadateľ je x zamestnaneckom pomere, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x nasl. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx predpisov. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx xxxxxxxľ poberá xxxxxxxx xôxxxxxx, dokladom, xxxxx môže dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx dôchodku. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o nich xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx ich xxxxxxxľ xxxxxx, xx xxxxxxx xx vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx na zdraví xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx jeho xxxxx.

Xxxx xxxxxxxxx xxxxxx xx xxxx, že xxxxxxxx xxxxx, ktorého xxx bol(a) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx peňažnú xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom xxxx xxxxx xxx v Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx podľa ust. §12 xxxxxx č. 209/1997 Zb., x xxxxxxxxxx peňažnej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx povinnosť do xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, a xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx na xxxxxxx, xx xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x mene štátu xxxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja xxxxxxxx xxxxxxxx bude taký xxxxxx odôvodňovať, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx a xxxxx xxxxxxx, xxxxx xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 písm. c) xxxxxx č. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx republiky po xxxxxxx xxxxxxxx o xxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx poradové xxxxx. Potom bude xxxxxxxxxx na xxxxxxx xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx mesiacov xx podaní xxxxxxxx x xxxxxxxxxx potrebných xxxxxxxx xxx xxxxx xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, prečo xxxxx xxxxxxx xxxxxxxx.

- X zmysle zákona č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx xx x xôxxxxxx trestného xxxx xxxx spôsobené poškodenie xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Za xxxx sa xxxxxxxx xx xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx rodičom, manželom xxxxx xxxxxxxx zomretého x xxxxxxx v xxxx jeho xxxxx x ním žila x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo xxx xxxxxxx poskytovať výživu.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx peňažitej pomoci xxxxxxx trestnej xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx už xxx je deň xxxxxxxxx trestného činu, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx po xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx v xôxxxxxx trestného xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx alebo vo xxxxx, xxxxx predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané xxxxxxx xxxxxxx x xxxxxxxx, xxxxxxx x súčet xxxxxxxx xxxxxxx, xxxxx xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx vo xxxxxx súčte nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Ak xxxx - po xxx, xxx jej xxxxxxxx xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx xx vyššia xxx xx, xxxxx xxxx podkladom xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx opäť, 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 zomrela (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň x xxxx jeho xxxxx s xxx xxxx x domácnosti, xxxxx xxx xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx poskytovať xxxxxx), xx xxxxxxxx peňažná xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x ak je xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx každej xxxxx xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx je potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx žiadať subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx plnenia. Xxx x xxxxxx ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx je xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx skutočnosť xôxx xxx dôvodom xxxxxxxxxxxxx peňažnej pomoci xxxľx zákona č. 209/1997 Zb. Xx však nevylučuje xxxxxxx xxxxx xxxx xxxxxxx.

- Upozorňujeme, xx xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx do xxxxxxx rokov xxx xxx poskytnutia pomoci xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx základe xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti xôxx x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx xxxx xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, celková výška xxxxx, xxxxx jej xxôxxxxxx, x výška xxxxxxx, ktorú obeť xxxxxxx.