Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Xxxxxxxxxx xx Applications for xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx to Xxxxxxx of Xxxxxxxx Xxxx pursuant xx Xxx No. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx the xxxxxxx of criminal xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx current xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx application xxx xxx xxxxxxxxx xx xxxxxxxxx support xxxxxxxx xx Xxx no. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in the xxxxxxxx xxxx xx xxx applicant - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who has xxxxxxxx bodily xxxx, xx the xxxxxxxx xx x person xxx xxx xxxx xx consequence xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx the xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx person ("representative") xx the xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, x xxxxx child xxxxxxxxxxx xx xxx/xxx parent) xx xx the xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx is xxxxxx xxx application xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx x xxxxx xx attorney (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a xxxx xx xxx birth xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx equivalent xxxxxxxx.

XXX. Xx the applicant xx x xxxxxxxx xx a xxxxxx xxx xxx xxxx xx consequenee xx xxx respective xxxxxxxx xxx, please xxxx xx xxx xxxxxxxx xxxx of xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Nationality:

7. Xxxxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxxx (x.x. father, daughter, xx xxxxxxxxxx xxxxxx xx common household)

If xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx in consequence xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx documents xxxxxxx xxxx xxx xxxxxxxx supported or xxx xx xxxxxxxxxx xx xxxxxxx the xxxxxxxx (xx xxx xxxx xx a xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx on xxx xxxxxxxxxx xx xxxxxxx xxx dependent; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx a xxxxxxxx certificate).

Xxxxxx xxxxxxx xxx xxxx xx which xxx xxxxx was xxxxxxxxx xxx, xx xxx victim xxxxxxx xxxxx xxx consequences xx the xxxxx xx a xxxxx xxxx, please xxxx xxxxxxx xxx xxxx xxx the xxxxxx xx which xxx xxxxxx xxxxxxx of xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx xxxxxxx report).

VI. Xxxxxx xxxxxxx xxx xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx reference xxxxxx of xxx xxxx xxxxxxx to xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, please xxxxxx xxx latest xxxxxxxx xx the xxxxxxxxxxxxxx xxxxxxxx justice xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx xxxxxxxxx).

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

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Xxxx xx xxxx VlIl xx xxx xxxxxxxxx xx x xxxxxxxx of xx xxxxxxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

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

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

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

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

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Xxxxxxxxx xx xxx provisions xx §2, section 2 xx Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx of x xxxxxx who xxxx in xxxxxxxxxxx xx a xxxxxxxx xxx xx xxxxxxxxxx xx xx x xxxxxx if xx xx xxx xx x parent, xxxxxx xx xxxxx of xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx xx xxx same xxxxxxxxx xx if xxx xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx or xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

Xx xxx applicant xx xxx xxxxxx xx x xxxxx xxx has xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx items XX - XXX.

Xxxxxx xxxxxx x point-based assessment xx xxxx and xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx be xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x treatment. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x social xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx only xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx xx relevant xxx xxx xxxxxxxx xx Act no. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx of §6, xxxxxxx 2 xx Xxx xx. 209/1997, no xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain suffered xx at least 100 xxxxxx.

Xxx xxxxxx may xxxxxx xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx to xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx lost income (§7, xxxxxxx 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx xx xxxxx xxx x xxxx xxx payment, xxxxx xx xx xxxx xx fill in xxxxx XII - XxX.

Xxxx xxxxxxxx xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx assistant xx xxxx out xx xxx home xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx have not xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx such expenses xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx them into xxxxxxxxxxxxx.

Xxxxxx attach xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx to xxx application.

If the xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx include a xxxxxxxxx xxxx his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx amended. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx person who xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x income situation xxxxxx xx xxxxxx, xx xxxxxxxxxxx cases xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x result of xxx xxxxxxxx xxx xx xxxxx X xxx x xxxxxx. X xxxx xxx xxx xxxx compensated xxx xxx xxxx 1 xxxx suffered xx x xxxxxx xx xxx xxxxxxxx xxx.

X hereby xxxxxx xxxx X xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx xx xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx act xx any xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Act Xx. 209/1997 Xxxx., xx xxx provision xx financial xxxxxxx xxx xxx xxxxxxx xx criminal acts xxx xx xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, X xx xxxxxxx to xxxxxxxxx xxx Xxxxxxxx xx Justice xxx xxxxxx received xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx the xxxxxx xx the financial xxxxxxx, xxxxxx five xxxxx from xxx xxxx of xxxxxxxxx xxx xxxxxxx support. X also acknowledge xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x xxxxx for xxx return xx xxx xxxxxxxx support, xxxxxx xxxx x xxxxxx xx well xxxxxxxx by my xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx received.

I also xxxxxxxxxxx xxxx consciously xxxxxx false xx xxxxxxxxxx information or xxxxxxxxxxx information for xxx xxxxxxxx of xxxxxxxxxxxxx xxxxxxx benefits xxx represent xx xxxxxxx pursuant to §21, section 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx applicant or xxx/xxx representative

- Xxxx xxxxxxx of xxx xxxxxxxxxxx for the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx confirm xxxxxxx xxx xxxxxx xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx with xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx per xxx xxxxxxxx xxxxxxx xx xxx xxxx. Within xxxxx xxxxxx from xxx xxxx xx xxx xxxxxxx of xxx xxxxxxxxxxx xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx the xxxxxxxxx of xxx xxxxxxx xxx xxxx xxxxxxx xxx xxxx xxxxxxxx.

- Xxx applicant xxxxx be considered x victim as xxx Xxx Xx. 209/1997 Xxxx. only xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x crime. X necessary but xxx the ohly xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx xx xxxxxxxx support xxxxx xx xxx amount xx the point-based xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx weakening of xxxxxx xxxxxxxx), xxxxx xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx be xxxxxxxxxx xx xx x xxxxxx if xxx xxxxxxxx xx a xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx shared a xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx xx if xxx xxxxxxxx supported xx xxx required xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx support to xxxxxxx xx criminal xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 xxxx from xxx date xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx caused xx xxx crime. Xx xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx xxx abovementioned xxxxxx.

- Financial xxxxxxx xx applied xxx xx x xxxxxx xxx xxx suffered xxxxxx harm xx x result xx xxx xxxxxxxxxx xx x crime xxx xx in the xxxx of x xxxx xxx xxxxxxxxx xx CZK 25,000 xx xx amount xxxxx xx xxxx xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx xxxxxx, xxxxxxx xx any xxxxxx xxxxxxxxxx paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx harm incurred. Xxx xxxxx amount xx xxxx xxxxxxx xxxx not exceed XXX 150,000. If, xxxxx xxx xxxxxxxxx xx support, the xxxxxx proves xxxx xxx xxxx suffered xxxxxxx the amount xxxxxxxx, the victim xxx receive xxxxxxxxxx xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx period of xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx); xx such xxxx, xxx amounts xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- Xx individual xxx xx x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx of xxx xxxxxxxxxx of x xxxxx (a xxxxxx, xxxxxx or child xx the xxxxxxxx xxxxxx in x xxxxxx xxxxxxxxx with xxx deceased xx xxx time xx xxx/xxx death xx xxxxxxxxx by xx xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx be xxxxxxxx with x xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx as xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx the number xx xxxxxxx xxxxxx xxxxx, the amount xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx xx xxx xxxxxxxxx liability of xxxxxxxxx xx xxxxx xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx isolated xxxxx, in view xx exceptional circumstances, xxx xx application xxx xxx xxxxxxxxx xx financial support xx filed xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please bear xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx xxx xxxxxxxxxx xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx xx xx so, xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx xxxxxxx xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x decision xx xxxxxxxx any xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. This xxxxx xxx, xxxxxxx, prejudice xxx filing xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx mind xxxx the xxxxxxxxx xxxxx be obliged xx xxxxxx xxx xxxxxxxxx amount xxxxxxxx xx compensation for xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx the Xxxxxxxx xx Justice up xx the amount xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx not xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx so xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Justice may xxxxx xxx xxxxx'x xxxxx xx claim xxx return xx xxx xxxxxxxxx support xxxxxxxx xxxxx xxx xxxxx of the xxxx-xxxx xxxx, xxxxxxxx xxxx a xxxxxx xx xxxxxxxxx by xxx xxxxxx'x social xxxxxxxx, the xxxxx xxxxxx xx xxx xxxx xxxxxxxx xxx xxx xxxxxx of xxxxxxxxxxxx paid xx xxx victim.

Vážený pán/pani/slečna

Ospravedlňujeme xx, že x xxxxxxxx, x ktorej xx nachádzate, sme xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti xxxľx zákona č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - obeti trestného xxxx, xxxxxx spôsobili xxxx xx zdraví, xxxxx osobe xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx iná xxxxx (zástupca) na xxxxxxx zákonného xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx rodičom) xxxxx xx xxxxxxx xxxxxx x xxxxx moci, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte kópiu xxxxx moci (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ alebo xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx x xxxxxxx xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx žiadateľa (xxxx, xxxxx, osoba xxxxxx x spoločnej domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu xxxxx - dieťa pôjde x rodný list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx pošty alebo xxxxxxxx na xxxxxxx xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx účtu.

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

Xxxxxx xxxxx xxxxxxxxx trestného xxxx x ak 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 xxxxxx (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx xxxxxxx o xxxxxxxx xxxx. Xxxxxx xx xxxxxxx xxxxxx, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx činného x xxxxxxxx konaní, xxxxx xxxx predstavu x xxx, x xxxx xxxxxx xx xxx xxxxxxxx (napr. uznesenie x xxxxxxxx trestného xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x žiadosti.

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

Xxxľx xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Zb)., xxxxxxxx xxxxx xx môže xxxxxx xxxxx sa xxxxxxxx x prihliadnutím xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, ktorá zodpovedá xx xxxxx. Tento xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx ste xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx xxôx spľňa xxxxx xxxxxxxxx, xx xx Xxx tieto xxxxxxxxxxx xxxxx.

1. Boli xxx xxxxxxx, xxxxxxxx xxxxx dieťaťom osoby, xxxxx zomrela v xôxxxxxx trestného xxxx?

2. Xxxx xxx x xxxxxx xxxxxxxxx činu xxxx vykonaním xxxxxxxxx xxxx v xxxxxxxxx xxxxxxxxxx?

3. Poskytovala Xxx xxxx trestného činu xxxxxx, či xxxx x tomu povinná?

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

Xxxľx xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Zb. sa xx obeť xxxxxxxx xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx xxxxxxxxx x xxxxxxx v xxxx xxxx smrti x xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx xxx povinný xxxxxxxxxx výživu.

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Body XX. xx XIV. Xxxxxxx, xx sa xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx spôsobená xxxx xx xxxxxx.

XX. Xxxxxx xxxxx, xxxx sa xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx skončila xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx xxxxxx ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx x xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, xx xxx xxxxx zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti nedosiahne xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx žiadate x xxxxxxxxxxx xxxxxxxx xxxxxx vo xxxxx xxxxxxxxx xxxxxxx 25 000.- Xx xxxxx či xxxxxxxx xxxxx xxxxxx xxxxxxx x nákladov xx liečenie.

Podľa xxxxxxxxxxx §7 odst. 1 xxxx. a) xxxxxx x. 209/1997 Zb. xx žiadosť xxxxx xxxxx poskytnúť xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na liečenie x xxxxxx xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx vyplňovať xxxx XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx náklady xx dopravu, x xxx. xxx xxxxxxxxxx, xx xxxxx xxxxxxx xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx sa xxxxx doložiť, inak xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx a xx xxxxxx xxxx na xxxxxx spôsobenej xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx x priemernom xxxxxxx xxxľx §351 x nasl. zákona x. 262/2006 Zb., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx samostatne xxxxxxxxx xxxxxx, takou listinou xxxx xxxxxxxxx opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx xxxxxxxľ poberá xxxxxxxx dôchodok, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x nejakého xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx pomery xxxxxxxľx, x krajnom prípade xx možné nahradiť xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx nemocenských xxxxx (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx xxx xxxxxxxľ poberá, xx xxxxxxx po vzniku xxxx xx zdraví, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. V xxxxxxx, xx x xôxxxxxx xxxxx na zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx výšku.

Xxxx xxxxxxxxx xxxxxx xx xxxx, že xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, že xxxxx na peňažnú xxxxx xx xxxxxxx xxxxx xx odškodnenie xxxx spôsobenej trestným xxxxx xxx xxxxxxxxxx(x) x žiadnom inom xxxxx xxx x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx xxxľx xxx. §12 xxxxxx č. 209/1997 Zb., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x o zmene x o doplnení xxxxxxxxxx zákonov, x xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, xxx mi xxxxxxxx pomoc, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, x xx až do xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx na xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby sa x mene štátu xxxxxx práva na xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, xxxxx xx spôsobili x xxxxx xxxxxxx, xxxxx xxx dostal(a).

Beriem xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx xxxxxx získania xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx priestupku xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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xxxxxx žiadateľa alebo xxxxxxxx

- Ministerstvo spravodlivosti Xxxxx republiky xx xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x udelí poradové xxxxx. Xxxxx bude xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx okolností prípadu. Xx troch xxxxxxxx xx podaní xxxxxxxx x predložení xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx x xxxxxxx, xx xx x xôxxxxxx trestného xxxx xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Za xxxx xx xxxxxxxx xx osoba pozostalá xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx dňa, xxx xx obeť dozvedela x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx xxxx xx xxx je xxx xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie peňažnej xxxxxx, xxxxx mu xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Pomoc xx xx xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, poskytne x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx x liečením, xxxxxxx x súčet xxxxxxxx čiastok, xxxxx xxxx x titulu xxxxxxx xxxxx už xxxxxxx; pomoc xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - po xxx, xxx jej xxxxxxxx xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx je xxxxxx xxx tá, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx v xxxxxx stanovenej xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx opäť, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx vyplatené.

- Fyzickej xxxxx, xxxxx je xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase jeho xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, či xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx xxxxxxx xxxxx v xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x ak je xxxxx obetí xxxx xxx tri xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx vozidiel, xx xxxxx xxxxäxxxx povinné xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach dopravných xxxôx žiadať xxxxxxx, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx plnenia. Len x xxxxxx ojedinelých xxxxxxxxx s xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx spravodlivosti x xxxxxxxxxxx peňažnej xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x potvrdenia, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx xxxxxxxľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx bude žiadateľovi xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je xx xxxxxxx rokov odo xxx xxxxxxxxxxx xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) až xx xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Na základe xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx vrátenie xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto xxxxxx xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, ktorú xxx xxôxxxxxx, a výška xxxxxxx, xxxxx obeť xxxxxxx.