Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Criminal Xxxx xxxxxxxx to Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx fulancial xxxxxxx xx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx certain xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx with xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx for the xxxxx xxxxxxxxxx xx xxxx application xxx xxx xxxxxxxxx xx xxxxxxxxx support pursuant xx Xxx xx. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx the xxxxxxxx xxx xxx has xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx has died xx consequence of xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Number:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx represented by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx statutory xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx parent) xx xx the xxxxx xx x xxxxx xx attorney, xxxxxx fill in xxx data of xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, please xxxx xxxxxx x xxxxxxxx authorizing xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx x xxxxx of xxxxxxxx (xxx xxxxxxxxxxx representation) xx x xxxx xx xxx birth xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx any xxxxx equivalent document.

III. Xx the applicant xx a survivor xx x xxxxxx xxx has xxxx xx consequenee xx xxx respective xxxxxxxx xxx, please fill xx xxx personal xxxx xx xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Xxxx of xxxxx:

4. Xxxx of xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx consequence xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx xxxxxxxxxxx xxx xxx documents xxxxxxx xxxx the xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx support the xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx xxxxxxxx xx xxx obligation to xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx married xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx on which xxx xxxxx was xxxxxxxxx xxx, if xxx victim learned xxxxx xxx consequences xx xxx crime xx a later xxxx, xxxxxx xxxx xxxxxxx the date xxx xxx xxxxxx xx which xxx xxxxxx learned of xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx medical xxxxxx).

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

If xxxxxxxxx, please attach xxx latest decision xx the abovementioned xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx otherwise).

According xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx made use xx all legal xxxxxxxx to xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx or xxx xxxxx person responsible xxx xxx xxxx xxxxxxxx. Xx xxx xxxx xx xxxx xxxx xx the xxxxxxxx has not xxxx identified.

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Fill in xxxx VlIl if xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx xxx xxx died in xxxxxxxxxxx of xxx xxxxxxxxx xxxxx.

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

2. Xxx xxx live xx a common xxxxxxxxx xxxx xxx xxxxxxxx person prior xx xxx xxxxxxxxxx xx the crime?

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

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

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Xxxxxxxxx xx xxx provisions xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx xx x victim who xxxx in xxxxxxxxxxx xx a xxxxxxxx xxx is xxxxxxxxxx xx xx x xxxxxx xx xx xx she is x xxxxxx, xxxxxx xx xxxxx xx xxx deceased xxx xxxxx xxxx xxx xx her xx xxx same household xx xx the xxxxxx was a xxxxxxxxx of xxx xxxxxxxx xx the xxxxxxxx xxx required xx xxxxxxx xxx xxxxxx.

Xx xxx xxxxxxxxx xx xxx xxxxxx xx a xxxxx xxx xxx suffered xxxxxx xxxx, please xxxx xx items XX - XIV.

Xxxxxx attach x xxxxx-xxxxx assessment xx xxxx and xxxxxxxxx pursuant to Xxxxxx Xx. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx xx xxx pam suffered xxx a xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx xx the xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx bear in xxxx xxxx xxxx xxx point-based assessment xx the xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx provisions xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx unless xxx xxxxx assessment xx xxx pain suffered xx at xxxxx 100 points.

The xxxxxx may obtain xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx of XXX 25,000 xx xx xxxxxx equal xx xxx proved xxxxx xx xxxxxxx xxxxxxxxx xxx lost xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx xxxxx xxx x xxxx xxx payment, there xx no need xx xxxx in xxxxx XXX - XxX.

This xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx xxxx or xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx xx xx insurance company. xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx is xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx xxxx his/her xxxxxxxx describing the xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Labour Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx of xxx/xxx xxxx recent xxx xxxxxx. xx xxx xxxxxxxxx is x xxxxxxx xxxxxx who xx able to xxxxx xxx/xxx impaired xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx the amount xx the retirement xxxxxxx. xx xxx xxx reason xxx xxxxxxxxx'x xxxxxx situation xxxxxx xx proven, xx xxxxxxxxxxx cases xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx xxx xx which X xxx x victim. X xxxx xxx xxx xxxx compensated xxx xxx xxxx 1 have xxxxxxxx xx x xxxxxx xx the criminal xxx.

X xxxxxx xxxxxx xxxx X have xxx lodged any xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx claim for xxxxxxxxxxxx for the xxxx suffered as x result of xxx xxxxxxxx act xx xxx xxxxxxx xxxxx xxxx the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 xx Act Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx financial support xxx xxx victims xx xxxxxxxx xxxx xxx on xxxxxxxx xxxxxxx other acts, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx any xxxxxx xxxxxxxx xx xxxxxxxxxxxx for the xxxx xxxxxxxx, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx five xxxxx xxxx xxx xxxx xx receiving xxx xxxxxxx support. X xxxx acknowledge xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx period, X xxx xxxx xx xxxxxxxxxxx asking xxx Xxxxxxxx xx Xxxxxxx xx xxxxx the xxxxx'x claim xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx such a xxxxxx be xxxx xxxxxxxx xx my xxxxxx xxxxxxxx, xxx xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount of xxxxxxxxxxxx xxxxxxxx.

X also xxxxxxxxxxx that xxxxxxxxxxx xxxxxx false or xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, section 1, xxxxxx c) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx of xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx of the xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx pursuant to Xxx No. 209/1997, xxx Xxxxxxxx of Xxxxxxx xxxxx xxxxxxx xxxxxxx and xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall xxxxxxxx xx investigation xxxx xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx per xxx xxxxxxxx xxxxxxx of xxx case. Within xxxxx months from xxx xxxx of xxx receipt xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx the xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx the xxxxxxx xx xxxxxx the xxxxxxxxx xx the xxxxxxx xxx such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx xxxxxxxxxx x victim xx xxx Act No. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx harm xx x result xx xxx commitment xx a xxxxx. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx for xxx xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx xxxxx xx xxx amount xx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), which xxxx be xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx who xxx xxxx in xxxxxxxxxxx xx x crime xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx of his/her xxxxx xx if xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Act Xx. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx support to xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 year xxxx xxx date xx xxxxx xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx. If xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx of xxx crime, the xxxxxx shall xxxxxxx xxxxxxxx xx the xxxx on xxxxx xx/xxx learned of xxx xxxxxxxxxxxx. The Xxxxxxxx of Xxxxxxx xxxxxx xxxx an xxxxxxxxxxx xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx the lapse xx xxx abovementioned xxxxxx.

- Xxxxxxxxx support xx applied xxx xx x xxxxxx xxx has xxxxxxxx xxxxxx xxxx as x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx xxx xx xx xxx xxxx xx x xxxx xxx xxxxxxxxx xx CZK 25,000 xx an xxxxxx xxxxx to xxxx xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx xx xxx xxxxxx previously paid xx xxx xxxxxx xx compensation xxx xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx xxx exceed XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx harm xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx victim xxx receive xxxxxxxxxx xxxxxxx up xx xxx amount of XXX 150,000 xx xx/xxx xxxxxxx for xx within the xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx harm xxxxxx by the xxxxx); xx xxxx xxxx, any amounts xxxxxxx xxxx xxxx xx taken xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx xx x xxxxxx xxx xxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx of a xxxxx (a parent, xxxxxx xx xxxxx xx xxx xxxxxxxx xxxxxx xx x xxxxxx household xxxx xxx xxxxxxxx xx xxx xxxx of xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx be xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx sum xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx financial xxxxxxx shall xxx xxxxxx CZK 450,000; xxxxxx the xxxxxx xx xxxxxxx exceed xxxxx, xxx xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Coll. does xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx xxxxxxx accidents, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx xx xxx insurers providing xxxx xxxxxxxxx insurance. Xxxx in xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx xx application xxx xxx xxxxxxxxx xx financial xxxxxxx xx xxxxx xxxx xxx Ministry of Xxxxxxx.

- Xxxxxx xxxx xx mind xxxx xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx must be xxxxxxxx xx xxx xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx so, xxx Xxxxxxxx xx Justice xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant xxxx xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx fact may xxxxxxx a xxxxxxxx xx withhold xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. This shall xxx, xxxxxxx, prejudice xxx filing of xxxxxxx xxxxxxxxxxx.

- Please xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx return any xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, insurers xxx.) xx the xxxxxxx xx the Ministry xx Xxxxxxx xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx not xxxxx xx he/she has xxx received any xxxxxxxxxxxx. If so xxxxxxxxx by the xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx state's xxxxx to xxxxx xxx xxxxxx xx xxx xxxxxxxxx support xxxxxxxx xxxxx the xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x waiver xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx total xxxxxx of the xxxx suffered xxx xxx xxxxxx of xxxxxxxxxxxx paid xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx zákona č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Prosím, xxxxxxx xxxxxxľxx xxxxxx xxxxx o žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx spôsobili xxxx xx zdraví, xxxxx xxxxx pozostalej xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) na xxxxxxx xxxxxxxxx zastúpenia (xxxx. maloleté xxxxx xxxxxx xxxxxxx) alebo xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx osobu, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx rodného xxxxx (x xxxxxxx zákonného xxxxxxxxxx) alebo xxx xxxxxxx xxxxxxx.

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

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx činu x xxxxx xxxxxxxľx (xxxx, xxxxx, osoba žijúca x xxxxxxxxx domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx priložiť kópia xxxxxxxx listu a xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, že xxxxxx xxxxx vyživovala xxxxxxxxx xxxxx xxxxx mala xxxxxxxxx ju xxxxxxxxx (xx xxxxxx xxxxx - xxxxx pôjde x xxxxx xxxx xxxxx rozhodnutie súdu x xxxxxxxxxxx povinnosti, xxx manželov xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx na xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx trestného činu x ak xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx neskôr, uveďte xxxx a xxx (xxxxxxxxx z xxxxxxxxx xxxxxx - xxxxx xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx konaní (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxx čine. Xxxxxx xx spisovú xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx činného x xxxxxxxx xxxxxx, xxxxx xxxx predstavu x xxx, x akom xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx xxôxxxxx ste xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx ustanovenia §8 xxxxxx č. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx xxxxxxx xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, ktorá xxxxxxxxx xx xxxxx. Tento xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

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

XXXX. Xxxxxx, či xxx xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx osôb spľňa xxxxx xxxxxxxxx, ak xx Xxx tieto xxxxxxxxxxx xxxxx.

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

2. Xxxx ste x xxxxxx xxxxxxxxx xxxx xxxx xxxxxxxxx xxxxxxxxx xxxx v xxxxxxxxx xxxxxxxxxx?

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

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

Podľa xxxxxxxxxxx §2 xxxx. 2 zákona č. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx žila x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx poskytoval xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx trestného xxxx x xxxx xx spôsobená ujma xx xxxxxx.

XX. Uveďte xxxxx, xxxx sa xxxxxxxx xxxxxxxx, respektíve xxxx sa skončila xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx bodového xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové xxxxxxxxxxx xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx a bodové xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, že xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 odst. 2 xxxxxx x. 209/1997 Zb. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x poskytnutie peňažnej xxxxxx xx výške xxxxxxxxx čiastky 25&xxxx;000.- Xx alebo či xxxxxxxx xxxxx ušlého xxxxxxx x xxxxxxxx xx liečenie.

Podľa 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 vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx sa rozhodnete xxxxxx x xxxxxxx xxxxx xx výške xxxxxxxxx čiastky, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Náklady xxxxxxx x xxxxxxxx xxxxxx:

Xxx x náklady xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx pojsťovňa. Xx xxxxxxx náklady xx xxxxx doložiť, xxxx xx ne ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

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

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. zákona x. 262/2006 Zb., xxxxxxxx práce, v xxxxx neskorších xxxxxxxxx. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx napríklad opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx potvrdenie x xxxxx starobného xôxxxxxx. X prípade, xx x xxxxxxxx závažného xôxxxx xxxxxxx doložiť xxxxxxxxx pomery žiadateľa, x xxxxxxx xxxxxxx xx možné nahradiť xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) a xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx na xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. V prípade, xx x dôsledku xxxxx na xxxxxx xxôxxxxxxx trestným činom Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx jeho xxxxx.

Xxxx xxxxxxxxx xxxxxx xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Škodu, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx som xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx xxxľx xxx. §12 xxxxxx č. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti x x zmene x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx pomoc, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx škody, a xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx s tým xxxxxx xx vedomie, xx po xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x mene xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx odôvodňovať, celková xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, xxxxx xxx dostal(a).

Beriem xxxx xx vedomie, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť priestupku xxxľx §21 odst. 1 xxxx. c) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x znení neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx republiky po xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx xx polícii xx na xxxx xxxxxxxx xxxxxx podľa xxxxxxxxxxx okolností prípadu. Xx troch xxxxxxxx xx podaní xxxxxxxx x predložení potrebných xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. bude žiadateľ xxxxxxxxxx za obeť xxx v xxxxxxx, xx xx x xôxxxxxx trestného xxxx xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx obeti xx výška bodového xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Za xxxx xx považuje xx xxxxx xxxxxxxxx xx xxxxx, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx jeho xxxxx x xxx žila x domácnosti, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx poskytovať výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx trestnej činnosti xxxxxxxxx prekluzívnu (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx činom. Ak xxxxx xxxx xx xxx xx xxx xxxxxxxxx trestného xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie peňažnej xxxxxx, xxxxx mu xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx x xôxxxxxx trestného xxxx xxxxxxx xxxxx xx xxxxxx, poskytne v xxxxxxxxx xxxx 25 000.- Xx xxxxx vo xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x liečením, xxxxxxx o súčet xxxxxxxx xxxxxxx, ktoré xxxx z xxxxxx xxxxxxx škody už xxxxxxx; xxxxx xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - po xxx, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx xx xxxxxx xxx tá, xxxxx xxxx xxxxxxxxx na xxxxxxxxxxx pomoci, na xxx xxxxxxx v xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx pomoc opäť, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Kč; pričom xx prihliadne na xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x čase xxxx xxxxx s ním xxxx x xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx bol xxxxxxx poskytovať výživu), xx xxxxxxxx xxxxxxx xxxxx v paušálnej xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x xx je xxxxx obetí viac xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx sa xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx plnenia. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx je xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx a xxxxxxx ani dodatočne xxxxxx, xxxx skutočnosť xôxx byť xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Upozorňujeme, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx rokov xxx xxx poskytnutia xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx dostal ako xxxxxxx škody (xx xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx povinnosť xxxx, xx xx xxxxx xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene štátu xx xxxxxxxx stanovenej xäxxxxxxx xxxx xxxxx xxxxx na xxxxxxxx xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx situácia xxxxx, xxxxxxx výška xxxxx, xxxxx jej xxôxxxxxx, x xxxxx xxxxxxx, xxxxx obeť xxxxxxx.