Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Criminal Xxxx pursuant to Xxx No. 209/1997 Xxxx., xx the xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx xx criminal xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, filling in xxxx questionnaire xx xxxxxxxx xxx the xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Act no. 209/1997. Xxxxx xxx xxx your xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please xxxxxxx xxxx xx xxx xxxxxxxx data xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx the criminal xxx xxx has xxxxxxxx bodily xxxx, xx xxx xxxxxxxx xx a xxxxxx xxx xxx xxxx xx consequence of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given name:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Number:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx applicant xx xxxxxxxxxxx xx xxxxxxx person ("representative") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx his/her parent) xx on xxx xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx fill xx xxx data of xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx is xxxxxx xxx application xx xxxxxx xx xxx xxxxxxxxx, please xxxx submit x xxxxxxxx authorizing him/her xx xxxxxxxxx the xxxxxxxxx - a xxxx of a xxxxx of xxxxxxxx (xxx contractual xxxxxxxxxxxxxx) xx x xxxx xx xxx xxxxx xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx xxxxxxxx.

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

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx applicant is x survivor xx x xxxxxx who xxxx in xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx attach x xxxx xx xxx xxxxx certificate xxx xxx xxxxxxxxx xxxxxxx that the xxxxxxxx supported or xxx xx obligation xx xxxxxxx the xxxxxxxx (in the xxxx of x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or a xxxxx xxxxxxxx on xxx xxxxxxxxxx to xxxxxxx xxx dependent; xx the case xx xxxxxxx xxxxxxx, xxxxxx xxxxxx a xxxxxxxx certificate).

Xxxxxx xxxxxxx xxx xxxx on xxxxx xxx xxxxx xxx xxxxxxxxx xxx, if xxx xxxxxx learned xxxxx the xxxxxxxxxxxx xx the crime xx a later xxxx, please also xxxxxxx xxx date xxx xxx xxxxxx xx which xxx xxxxxx learned xx xxxx consequences (e.g., xxx xxxx xx xxx medical xxxxxx).

XX. Xxxxxx specify xxx xxxxxxxx xxxxxxx authority (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx most recently xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx related xx xxx respective proceedings.

If xxxxxxxxx, xxxxxx attach xxx xxxxxx xxxxxxxx xx xxx abovementioned xxxxxxxx xxxxxxx authority xxxxx xxxxx indicate xxx xxxxx of xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx of xxxxxxxx prosecution, xxxx xx the indictment, xxxxxxxxx - xxxxx xx otherwise).

According xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx xxxxxx of xxxxxxxxx xxxxxxx may xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx xxxx xxx xx all xxxxx xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx against xxx xxxxxxxx xx xxx xxxxx xxxxxx responsible xxx the harm xxxxxxxx. Xx xxx xxxx xx this xxxx xx xxx xxxxxxxx xxx not xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx xx xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx you a xxxxx, spouse or xxxxx xx the xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx xxxxxxx?

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

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

4. Xx xxx xxxxx xxxxxxx xxxx the xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 to 3? Please give xxxxx number, if xxxxx xx you.

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According xx the xxxxxxxxxx xx §2, section 2 of Xxx xx. 209/1997, x xxxxxx xxx is x survivor of x victim xxx xxxx in consequence xx a criminal xxx xx xxxxxxxxxx xx be x xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx child of xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx xx xxx same household xx if xxx xxxxxx was a xxxxxxxxx of xxx xxxxxxxx or xxx xxxxxxxx was required xx xxxxxxx xxx xxxxxx.

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

Please xxxxxx x point-based xxxxxxxxxx xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. The respective xxxxxxxx should xx xxxxxxxx from the xxxxxxxxx xxxxxxxxxxx for xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx report xxxx contain a xxxxx-xxxxx assessment xx xxx xxx xxxxxxxx xxx a xxxxx-xxxxx xxxxxxxxxx of the xxxxxxxx xx the xxxxxx'x social position. Xxxxxx bear xx xxxx xxxx xxxx xxx xxxxx-xxxxx assessment xx xxx xxx xxxxxxxx xx xxxxxxxx xxx xxx purposes xx Xxx no. 209/1997. According xx xxx provisions xx §6, xxxxxxx 2 xx Act no. 209/1997, no xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx of xxx xxxx xxxxxxxx xx xx least 100 points.

The xxxxxx xxx obtain xxxx sum xxxxxxxxx xxxxxxx in the xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx treatment xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx x of Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx x lump xxx payment, xxxxx xx xx xxxx xx fill xx xxxxx XXX - XxX.

Xxxx includes xxx xxxxxxxx xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx out xx xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., provided such xxxxx xxxx xxx xxxx paid by xx xxxxxxxxx company. xx such xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Ministry xx Xxxxxxx may not xxxx them into xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx application.

If the xxxxxxxxx xx xx xxxxxxxx, these xxxxxxxxx xxxxx include x xxxxxxxxx from his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx amended. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx who xx xxxx xx xxxxx xxx/xxx impaired xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx exceptional xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx of xxx xxxxxxxx act xx xxxxx I xxx a xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx the xxxx 1 xxxx suffered xx x xxxxxx xx the xxxxxxxx xxx.

X xxxxxx affirm xxxx I xxxx xxx xxxxxx any xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx suffered xx x xxxxxx xx xxx criminal xxx xx any xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx support xxx the xxxxxxx xx criminal xxxx xxx xx amending xxxxxxx other xxxx, xx xxxxxxx, I xx obliged xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx xxx amount xx xxx financial xxxxxxx, xxxxxx five xxxxx from the xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X also xxxxxxxxxxx xxxx, xxxxx xxx xxxxx of the xxxx-xxxx xxxxxx, X xxx file xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Justice xx xxxxx the xxxxx'x xxxxx xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx xxxx a xxxxxx xx well xxxxxxxx by xx xxxxxx xxxxxxxx, xxx xxxxx extent xx xxxx suffered and xxx xxxxxx of xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx information xxx xxx xxxxxxxx xx xxxxxxxxxxxxx gaining benefits xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, section 1, xxxxxx x) xx Xxx no. 200/1990 Xxxx., on offences xx amended.

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Signature of xxx xxxxxxxxx or xxx/xxx representative

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant xx Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx assign xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx investigation xxxx xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx receipt of xxx xxxxxxxxxxx and xxxxxxxxxx xx the xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx support xx xxxxxx xxx xxxxxxxxx of xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx be xxxxxxxxxx x xxxxxx as xxx Act Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx the xxxxxxxxxx xx x crime. X necessary but xxx the ohly xxxxxxxxx for xxx xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx the amount xx the point-based xxxxxxxxxx xx xxx xxx suffercd (not xxx weakening xx xxxxxx position), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx of x xxxxxx xxx has xxxx in xxxxxxxxxxx xx x xxxxx xxxxx be xxxxxxxxxx xx be x xxxxxx if xxx xxxxxxxx is x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx xxx xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx at the xxxx of his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx was xxxxxxxx xx support xxx xxxxxxxx.

- Xxx No. 209/1997 Xxxx. xx xxx provision xx xxxxxxxxx xxxxxxx to xxxxxxx xx xxxxxxxx xxxx stipulates x xxxxxxxxxx xxxx xx 1 year xxxx xxx date xx xxxxx the xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx. Xx xxxx xxxx does xxx xxxxxxxx with xxx xxxx of xxx xxxxxxxxxx of xxx xxxxx, the xxxxxx xxxxx provide xxxxxxxx xx the xxxx on which xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx xx Justice xxxxxx meet xx xxxxxxxxxxx for xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied xxx xx x victim xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx xxx xx in the xxxx xx a xxxx sum amounting xx CZK 25,000 xx an amount xxxxx xx xxxx xxxxxx or xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx xxxxxx, xxxxxxx xx xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx support xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, the victim xxx xxxxxxx additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx for xx within xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx from xxx xxxx xx which xxx xxxxxx xxxxxxx xx the xxxx xxxxxx by the xxxxx); in xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx xxxx xx xxxxx into xxxxxxx.

- Xx individual xxx is x xxxxxxxx xx a xxxxxx xxx xxx xxxx xx x xxxxxx xx the xxxxxxxxxx of a xxxxx (a parent, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx in a xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx time of xxx/xxx death xx xxxxxxxxx xx xx xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx xxxx x xxxx sum xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx xxx number xx xxxxxxx exceed xxxxx, the amount xxxxxxxx per victim xxxxx xx reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. does xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx isolated xxxxx, in xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx xxx provision xx xxxxxxxxx xxxxxxx xx filed with xxx Ministry xx Xxxxxxx.

- Xxxxxx xxxx xx mind that xxx xxxxxxxxx xxxxxxxxx xxx confirmations required xxx xxx xxxxxxxxxx xxxxx must xx xxxxxxxx xx the xxxxxxxxxxx. Xx xxx xxxxxxxxx fails to xx so, xxx Xxxxxxxx xx Xxxxxxx xxxxxx properly process xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx documents xxx xxxxxxxxxxxxx even xxxxxx x supplementary xxxxxxxx, xxxx xxxx xxx xxxxxxx a xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, xxxxxxxxx xxx filing xx xxxxxxx xxxxxxxxxxx.

- Please xxxx xx mind xxxx the xxxxxxxxx xxxxx xx obliged xx xxxxxx xxx xxxxxxxxx xxxxxx received xx compensation for xxxx (from xxx xxxxxxxx, xxxxxxxx etc.) xx the xxxxxxx xx xxx Ministry xx Justice xx xx xxx amount xx xxx support xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx he/she xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx to claim xxx return of xxx xxxxxxxxx support xxxxxxxx after xxx xxxxx of xxx xxxx-xxxx xxxx, provided xxxx a waiver xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxx xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, v ktorej xx nachádzate, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx posúdenia Xxxxx žiadosti x xxxxxxxxxxx peňažnej pomoci xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx osobe xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

II. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (zástupca) xx xxxxxxx zákonného zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) alebo xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx inú osobu, xxxx xx doložiť xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx k xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) alebo xxxxx xxxxxxx xxxxx (x prípade zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx x umretej xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x dôsledku xxxxxxxxx xxxx k xxxxx žiadateľa (xxxx, xxxxx, xxxxx žijúca x xxxxxxxxx domácnosti):

Ak xx žiadateľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx činu zomrela, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx listu a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - xxxxx xôxxx x xxxxx list xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx povinnosti, xxx xxxxxxxx takou xxxxxxxx xxxx xxxxxxx xxxx a pod.)

IV. Xxxxxx, xx žiadate xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; x takom xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

X. Xxxxxx xxxxx, kedy xx obeť xxxxxxxxx x škode spôsobenej xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx trestného xxxx x xx xx xxxx o xxxxx xxx spôsobenej dozvedela xx xxxxôx, xxxxxx xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx konaní (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx o xxxxxxxx čine. Xxxxxx xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

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

XXX. Xxxxxx, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa ustanovenia §8 xxxxxx x. 209/1997 (Xx)., peňažitá xxxxx sa môže xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, či xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx na xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx inej xxxxx, ktorá zodpovedá xx škodu. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx XXXX. Vyplňte, xx xxxxxxxľ xx xxxxxxxxxx xx osobe, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx.

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

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

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

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

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

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

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Xxxx XX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx obeťou xxxxxxxxx xxxx a bola xx xxôxxxxxx ujma xx zdraví.

IX. Xxxxxx xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx skončila xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx bodového ohodnotenia xx bolesť xxxx:

X xxxxxxxx sa xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x bodové xxxxxxxxxx xxxxxxxx spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 odst. 2 zákona x. 209/1997 Xx. nemožno xxxxxxxxx' peňažnú xxxxx, xx bodové ohodnotenie xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Xxxľx ustanovenia §7 odst. 1 xxxx. x) zákona x. 209/1997 Xx. xx žiadosť xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx xx xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx vo výške xxxxxxxxx čiastky, xxxxxxxx xx vyplňovať body XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, zdravotnícke xxxôxxx, náklady xx xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx na pomoc x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, x xxx. pod podmienkou, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx pomery žiadateľa xxxx a po xxxxxx xxxx na xxxxxx spôsobenej trestným xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ xx x zamestnaneckom pomere, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x priemernom xxxxxxx podľa §351 x xxxx. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx predpisov. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx listinou xxxx xxxxxxxxx opis xxxxxxxxxx daňového xxxxxxxxx. Xx žiadateľ poberá xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx sociálnu situáciu, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx xôxxxxxx. X prípade, že x nejakého závažného xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx žiadateľa, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx nemocenských dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx xx xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx xxxxx poisťovne x výške nemocenských xxxxx. X xxxxxxx, xx x dôsledku xxxxx na xxxxxx xxôxxxxxxx trestným činom Xxx priznali xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx jeho výšku.

Xxxx xxxxxxxxx xxxxxx xx také, xx xxxxxxxx xxxxx, xxxxxxx xxx bol(a) obeťou, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Škodu, xxxxx xx xxxxx xxôxxxxx, dosiaľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx inom xxxxx xxx x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx vedomie, xx xx xxxľx ust. §12 xxxxxx č. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx neskorších xxxxxxxxx, xxxxxx povinnosť xx xxxxxxx xxxxx odo xxx, keď xx xxxxxxxx pomoc, odviesť xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, x xx xx do xxxxx xxxxxxxxxxx pomoci. Xxxxxxx s xxx xxxxxx xx vedomie, xx xx uplynutí xxxxxxxxxx päťročnej doby xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx práva xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja sociálna xxxxxxxx bude taký xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, ktorú xx spôsobili x xxxxx xxxxxxx, xxxxx xxx dostal(a).

Beriem xxxx xx vedomie, xx xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx xxxx zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, sa xôxxx dopustiť xxxxxxxxxx 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

- Ministerstvo spravodlivosti Xxxxx republiky xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx xx inom xxxxxxxx orgáne xxxľx xxxxxxxxxxx okolností xxxxxxx. Xx xxxxx mesiacov xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx alebo žiadateľovi xxxxxx xôxxxx, prečo xxxxx xxxxxxx poskynúť.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx činu xxxx xxôxxxxxx poškodenie xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx peňažnej xxxxxx xxxxx obeti xx výška xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 bodov. Xx xxxx sa považuje xx osoba pozostalá xx obeti, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xxxx xxxxxxx, manželom xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx xxxxxxxxx xxxxxxxxxxx (prepadnú) xxxx 1 xxxx xxx xxx, keď xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx xxxx xx xxx xx deň xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx žiadostiam x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx xxxxx xx xxxxxx, poskytne v xxxxxxxxx sume 25&xxxx;000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu na xxxxxxx, xxxxxxxxxx náklady xxxxxxx x liečením, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx xxxxx xxxxxx xxxxxxxxxx sumu 150&xxxx;000.- Xx. Xx xxxx - xx xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx xxx vzniknutá xxxxx xx vyššia xxx tá, xxxxx xxxx podkladom xx xxxxxxxxxxx xxxxxx, xx xxx žiadosť x xxxxxx xxxxxxxxxx týmto xxxxxxx jej možno xxxxxxxxx xxxxx xxäx, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx, xxxxx xxx zomretý xxxxxxxxxx, xx bol xxxxxxx poskytovať xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x paušálnej xxxx 150&xxxx;000.- Kč; xxxxx vo xxxxxx xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Kč, x xx je xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx kráti.

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

- Xxxxxxxxxxx, že xx nevyhnutné xxxxxxxx xxxxxx xxxxxxxx doklady x potvrdenia, na xxxxx xxxxxxxxxx pri xxxxxxxxxxxx položkách. Ak xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx potvrdenia a xxxxxxx xxx dodatočne xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx bude xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx na xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx dostal ako xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx xxxx, xx xx škodu xxxxxxxxxx. Xx základe xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti môže x xxxx štátu xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx postup xxôxxxxxxx sociálna situácia xxxxx, celková xxxxx xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx obeť xxxxxxx.