Plné znění - 241/2006 Sb.

Questionnaire xxx the Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx xx Xxxxxxx of Criminal Xxxx pursuant to Xxx No. 209/1997 Xxxx., on xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, as xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, filling in xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx application xxx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Act no. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who has xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx a xxxxxx xxx xxx xxxx xx consequence of xxx criminal xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Phone Xxxxxx:

7. X-xxxx address:

8. Nationality:

II. Xx xxx xxxxxxxxx xx represented xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx represented xx his/her parent) xx xx the xxxxx xx x xxxxx of attorney, xxxxxx fill in xxx xxxx xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the application xx behalf xx xxx xxxxxxxxx, please xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx the xxxxxxxxx - x xxxx xx a xxxxx xx xxxxxxxx (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx x xxxx xx xxx birth xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx x person xxx has died xx xxxxxxxxxxx xx xxx xxxxxxxxxx criminal xxx, please fill xx xxx personal xxxx of xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx the xxxxxxxx xx the xxxxxxxxx (x.x. father, xxxxxxxx, xx individual xxxxxx xx common xxxxxxxxx)

Xx xxx xxxxxxxxx xx x xxxxxxxx xx x person who xxxx in xxxxxxxxxxx xx the xxxxxxxx xxx, please attach x copy of xxx death certificate xxx xxx xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx supported or xxx an xxxxxxxxxx xx support xxx xxxxxxxx (xx xxx xxxx of x xxxxxx-xxxxx relationship, such xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx married xxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxxx).

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

XX. Xxxxxx specify the xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, xxxxxx xxxxxxxxxx'x xxxxxx, court) xxxxx most xxxxxxxx xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx related xx xxx respective proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx decision xx xxx abovementioned xxxxxxxx justice authority xxxxx could indicate xxx xxxxx of xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx on xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx indictment, xxxxxxxxx - xxxxx xx otherwise).

According xx the provisions xx §8 xx Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx xxxx use xx all xxxxx xxxxxxxx to xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx or xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx not xxxx xx xxxx xxxx if xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx xxxxxxxxx xx x xxxxxxxx xx xx xxxxxxxxxx who xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

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

2. Xxx you live xx x common xxxxxxxxx xxxx xxx xxxxxxxx person prior xx xxx commitment xx the xxxxx?

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

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

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According xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx of x victim who xxxx xx consequence xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx a xxxxxx xx he xx xxx is x parent, xxxxxx xx child xx xxx xxxxxxxx xxx xxxxx xxxx xxx xx xxx xx xxx xxxx xxxxxxxxx xx xx xxx xxxxxx was a xxxxxxxxx xx xxx xxxxxxxx xx the xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the xxxxxxxxx xx xxx victim xx x crime xxx xxx xxxxxxxx xxxxxx harm, xxxxxx xxxx in xxxxx XX - XIV.

Xxxxxx xxxxxx x point-based xxxxxxxxxx xx pain xxx xxxxxxxxx xxxxxxxx to Xxxxxx No. 440/2001 Xxxx. Xxx respective xxxxxxxx xxxxxx be xxxxxxxx from the xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx assessment of xxx xxx xxxxxxxx xxx x point-based xxxxxxxxxx of the xxxxxxxx xx xxx xxxxxx'x social position. Xxxxxx xxxx in xxxx xxxx xxxx xxx xxxxx-xxxxx assessment xx xxx pam xxxxxxxx xx relevant xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According xx xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Xxx no. 209/1997, xx xxxxxxxxx xxxxxxx xxxx be xxxxxxxx unless xxx xxxxx xxxxxxxxxx of xxx xxxx xxxxxxxx xx at least 100 xxxxxx.

Xxx xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx xx the xxxxxx of XXX 25,000 xx xx xxxxxx xxxxx to xxx xxxxxx xxxxx xx medical treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). lf xxx xxxxxx to xxxxx xxx x lump xxx xxxxxxx, xxxxx xx no need xx fill xx xxxxx XXX - XxX.

Xxxx includes xxx xxxxxxxx xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx xx xxxx xxx in xxx home xx xxxx medical treatment, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx such xxxxx xxxx xxx xxxx xxxx xx xx xxxxxxxxx company. xx such xxxxxxxx xxx xxx proved xx xxxxxxxxxxx evidence, xxx Xxxxxxxx of Xxxxxxx may xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx facts xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx xx xx xxxxxxxx, xxxxx documents xxxxx include x xxxxxxxxx xxxx xxx/xxx xxxxxxxx describing xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx be a xxxx of his/her xxxx xxxxxx xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx xxxxxx who xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx a xxxxxxxx xxxxxxxxxx xxx xxxxxx xx xxx xxxxxxxxxx xxxxxxx. lf xxx xxx reason the xxxxxxxxx'x income situation xxxxxx xx proven, xx xxxxxxxxxxx cases xx affidavit xxx xx attached.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx of xxx criminal xxx xx xxxxx I xxx x xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx xxx harm 1 xxxx xxxxxxxx xx x xxxxxx xx xxx criminal xxx.

X xxxxxx affirm xxxx I have xxx lodged xxx xxxxx xxx xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx for xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx criminal act xx xxx country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx to §12 of Xxx Xx. 209/1997 Coll., xx the provision xx xxxxxxxxx support xxx the xxxxxxx xx criminal acts xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, I xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Justice xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx, xx xx xxx amount xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx receiving xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, after xxx xxxxx xx xxx xxxx-xxxx xxxxxx, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx waive the xxxxx'x claim for xxx xxxxxx xx xxx xxxxxxxx support, xxxxxx xxxx x xxxxxx xx well xxxxxxxx by xx xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of xxxx xxxxxxxx and xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false or xxxxxxxxxx information xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx c) of Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx the xxxxxxxxxxx xxx xxx xxxxxxxxx of financial xxxxxxx xxxxxxxx to Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx xxx assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall initiate xx investigation xxxx xxx police or x similar authority xx per the xxxxxxxx xxxxxxx of xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx receipt of xxx application xxx xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxx xxxxxxx xxx support xx inform xxx xxxxxxxxx xx the xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx applicant xxxxx be considered x xxxxxx as xxx Xxx Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx a xxxxxx xx xxx xxxxxxxxxx xx a xxxxx. X necessary but xxx the xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx support xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx suffercd (not xxx xxxxxxxxx of xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx who xxx xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx the xxxxxxxx is x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx xx xx xxx xxxxxxxx supported xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxxxx xx criminal xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 xxxx xxxx xxx xxxx xx xxxxx the victim xxxxxxx of xxx xxxx caused by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx with xxx xxxx xx xxx xxxxxxxxxx of xxx xxxxx, the xxxxxx shall xxxxxxx xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx an xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx support xx xxxxxxx xxx xx x xxxxxx xxx xxx suffered xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x xxxxx may xx xx xxx xxxx of x xxxx sum amounting xx XXX 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx xxx xxxxx of xxxxxxx xxxxxxxxx xx xxxxxx xx xxx victim, xxxxxxx xx any xxxxxx xxxxxxxxxx paid xx xxx victim xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx xxxxxxx, the xxxxxx xxxxxx that xxx xxxx xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx victim xxx receive xxxxxxxxxx xxxxxxx xx to xxx amount of XXX 150,000 xx xx/xxx xxxxxxx xxx xx within the xxxxxxxxxxxxxx xxxxxx xx xxxx (i.e., 1 xxxx from the xxxx xx xxxxx xxx xxxxxx learned xx xxx xxxx xxxxxx by the xxxxx); xx such xxxx, any xxxxxxx xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx a xxxxxx xx the xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx time xx xxx/xxx death xx xxxxxxxxx xx xx xxxxxxxx to xx xxxxxxxxx xx the xxxxxxxx) xxxxx be xxxxxxxx xxxx a xxxx xxx xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx per xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. xxxx xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of motor xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx insurance xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx an application xxx the provision xx financial support xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx bear xx mind xxxx xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx respective xxxxx xxxx be xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx to xx xx, xxx Xxxxxxxx of Xxxxxxx xxxxxx properly xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx deliver any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even within x supplementary deadline, xxxx fact xxx xxxxxxx x xxxxxxxx xx withhold xxx xxxxxxx xx per Xxx Xx. 209/1997 Xxxx. This xxxxx xxx, however, xxxxxxxxx xxx xxxxxx of xxxxxxx application.

- Xxxxxx xxxx in xxxx xxxx the xxxxxxxxx xxxxx be xxxxxxx xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx 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 xxx apply xx he/she xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. If xx xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx to xxxxx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx the xxxx-xxxx xxxx, provided xxxx x xxxxxx xx xxxxxxxxx by xxx victim's xxxxxx xxxxxxxx, the xxxxx xxxxxx xx xxx xxxx xxxxxxxx and xxx amount of xxxxxxxxxxxx xxxx xx xxx victim.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, v ktorej xx nachádzate, sme xxxxxx Xxx obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx dotazníku nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne xxxxxx xxxxx o žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx spôsobili xxxx xx xxxxxx, xxxxx xxxxx pozostalej xx xxxxx, ktorá x xôxxxxxx trestného xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx osobu, xxxx xx xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) alebo xxxxx xxxxxxx xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo inú xxxxxxx listinu.

III. Xx xxxxxxxľ alebo xxxxx xxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela, xxxxxxx, prosím, xx xxxxx x umretej xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

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

Xx xx xxxxxxxľ osobou xxxxxxxxxx po osobe, xxxxx v xôxxxxxx xxxxxxxxx činu zomrela, x žiadosti xx xxxx xxxxxxxx xxxxx xxxxxxxx listu x xxxxxxx, ktoré dokladajú xxxxxxxxxx, že xxxxxx xxxxx vyživovala xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx rodič - xxxxx pôjde x xxxxx xxxx xxxxx rozhodnutie xxxx x vyživovacej xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx sobášny xxxx x pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx oznámte xxxxx Xxxxx účtu.

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

Xxxxxx dátum xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx neskôr, uveďte xxxx x xxx (xxxxxxxxx z xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx konanie x xxxxxxxx xxxx. Xxxxxx xx xxxxxxx značku, xxx xxxxxx xxxxxxxx xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx posledné rozhodnutie xxxxxx xxxxxxx v xxxxxxxx xxxxxx, ktoré xxxx xxxxxxxxx o xxx, v xxxx xxxxxx sa xxx xxxxxxxx (xxxx. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Xxxxxx, xxxx spôsobom xxx xxxxxxxxx xxxxx na xxxxxxx škody od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona č. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx sa xxxxxxxx x prihliadnutím xx xx, xx xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Vyplňte, xx xxxxxxxľ je xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 xxxxxx č. 209/1997 Zb., xxxxxxxx xxľxx osôb spľňa xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

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

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

3. Xxxxxxxxxxx Vám xxxx xxxxxxxxx činu xxxxxx, či xxxx x xxxx xxxxxxx?

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

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Zb. sa xx xxxx považuje xxxxx pozostalá xx xxxxx, ktorá x xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx zomretého a xxxxxxx v xxxx xxxx smrti x xxx xxxx x xxxxxxxxxx xxxxx osoba, xxxxxx nebohý poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XXX. Xxxxxxx, xx sa žiadateľ xxxx obeťou xxxxxxxxx xxxx a xxxx xx xxôxxxxxx xxxx xx zdraví.

IX. Xxxxxx xxxxx, xxxx sa xxxxxxxx liečenie, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx 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 ho xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx a xxxxxx xxxxxxxxxx sťaženia xxxxxxxxxxxxx xxxxxxxxxx. Xxxxxxxxxxx, že xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

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

Podľa ustanovenia §7 xxxx. 1 xxxx. a) xxxxxx x. 209/1997 Xx. xx žiadosť xxxxx xxxxx xxxxxxxxx xxxxxxx xxxxx xx výške xxxxxxxxx sumy 25&xxxx;000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx sa rozhodnete xxxxxx o xxxxxxx xxxxx xx xxxxx xxxxxxxxx čiastky, xxxxxxxx xx vyplňovať xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, x xxx. xxx podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx žiadateľa xxxx x po xxxxxx ujmy xx xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx žiadateľ xx x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx je xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ poberá xxxxxxxx xôxxxxxx, dokladom, xxxxx môže xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, že x nejakého závažného xôxxxx nemožno doložiť xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx možné nahradiť xxxxxxxxxx x xxxx xxxxxxx vyhlásením.

XIV. Xxxxxx xxxxx nemocenských xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, odkedy xxx xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx xx zdraví, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx priložte potvrdenie xxxxxxxxxxxxľx alebo xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X prípade, xx x xôxxxxxx xxxxx xx xxxxxx xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx pomery xx také, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx zhoršila. Škodu, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx na xxxxxxx xxxxx či obdobný xxxxx na odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom xxxx xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx podľa xxx. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x doplnení xxxxxxxxxx xxxxxxx, x xxxxx neskorších predpisov, xxxxxx povinnosť do xxxxxxx rokov xxx xxx, xxx xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Ministerstva xxxxxxxxxxxxxx čiastky, ktoré xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx až do xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx po xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx xxxxx na xxxxxxxx poskytnutej pomoci, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx spôsobili x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx xxxxxxxx nesprávneho xxxxx xxxxxxxxx xxxxx xx xxxx xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx priestupku xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x znení neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx republiky po xxxxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx na polícii xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx mesiacov xx podaní xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx dôvody, prečo xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie peňažnej xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 bodov. Xx xxxx sa xxxxxxxx xx osoba xxxxxxxxx xx obeti, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx dieťaťom xxxxxxxxx x xxxxxxx v xxxx jeho xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx zomretý xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 xxxx xxx xxx, keď xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx okamžik, xxxx xx to xxxxx. Xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Pomoc xx na xxxxxxx xxxxx, ktorej x xôxxxxxx xxxxxxxxx xxxx xxxxxxx škoda xx xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25 000.- Xx alebo xx xxxxx, ktorá predstavuje xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx s liečením, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, ktoré xxxx x titulu xxxxxxx xxxxx už xxxxxxx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx tom, xxx jej poskytli xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx xx xxxxxx xxx tá, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx pomoci, xx xxx xxxxxxx x xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx až xx maximálnej xxxxx 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx xx xxxxxxx, xxxxx xx xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu zomrela (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne xxxxxxx xxxxx v paušálnej xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Xx, x xx je xxxxx obetí viac xxx xxx xxxxx, xxxxxxxxxxx čiastka sa xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je potrebné x xxxxxxxxxxxxxx dopravných xxxôx xxxxxx subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx nevyhnutné priložiť xxxxxx xxxxxxxx doklady x xxxxxxxxxx, na xxxxx odkazujeme pri xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx nemôže xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx xxxxxx ako xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx nemá, xx mu xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti xôxx x xxxx štátu xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, celková xxxxx xxxxx, xxxxx jej xxôxxxxxx, a xxxxx xxxxxxx, xxxxx obeť xxxxxxx.