Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx xx Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxx xxxxxxx xx criminal xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, as amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx is xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support pursuant xx Act xx. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please legibly xxxx xx the xxxxxxxx xxxx xx xxx applicant - x.x. the xxxxxx xx the criminal xxx xxx xxx xxxxxxxx xxxxxx harm, xx xxx xxxxxxxx xx a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Given name:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

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

6. Phone Number:

7. X-xxxx address:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("representative") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx instance, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx xxx xxxxx xx x xxxxx of attorney, xxxxxx fill in xxx data xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx registered address:

If xxx xxxxxxxxxxxxxx xx xxxxxx xxx application xx xxxxxx of xxx applicant, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx a xxxxx of xxxxxxxx (xxx contractual xxxxxxxxxxxxxx) xx a xxxx xx xxx xxxxx xxxxxxxxxxx (xxx xxxxxxxxx xxxxxxxxxxxxxx) or xxx xxxxx equivalent document.

III. Xx xxx applicant xx x survivor xx a xxxxxx xxx xxx died xx xxxxxxxxxxx xx xxx respective xxxxxxxx xxx, xxxxxx fill xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxx of xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx applicant xx x xxxxxxxx of x person xxx xxxx in consequence xx xxx criminal xxx, xxxxxx xxxxxx x xxxx xx xxx death xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx that the xxxxxxxx supported xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx xxx xxxx xx a xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or x xxxxx decision xx xxx xxxxxxxxxx to xxxxxxx the dependent; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx attach x xxxxxxxx certificate).

Xxxxxx xxxxxxx the xxxx xx which xxx xxxxx xxx xxxxxxxxx and, xx xxx victim xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx x later xxxx, xxxxxx also xxxxxxx the xxxx xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx proceedings. Xxxxx xxx xxxxxxxxx xxxxxx xx the xxxx xxxxxxx xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx the abovementioned xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx stage xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx xx xxxxxxxx prosecution, xxxx xx xxx indictment, xxxxxxxxx - final xx xxxxxxxxx).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx may xx xxxxxxx xx xxxxxxxx depending on xxxxxxx the xxxxxx xxx xxxx xxx xx xxx legal xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx or any xxxxx xxxxxx responsible xxx xxx xxxx xxxxxxxx. Xx not xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx identified.

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Fill xx xxxx VlIl if xxx xxxxxxxxx xx x xxxxxxxx of xx xxxxxxxxxx who xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxxx crime.

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

2. Xxx xxx live xx x xxxxxx xxxxxxxxx with xxx xxxxxxxx xxxxxx xxxxx xx xxx commitment xx the crime?

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

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

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Xxxxxxxxx xx the xxxxxxxxxx xx §2, xxxxxxx 2 xx Act xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx xx x victim xxx xxxx xx xxxxxxxxxxx xx a xxxxxxxx xxx is considered xx xx x xxxxxx if he xx xxx is x xxxxxx, xxxxxx xx child xx xxx deceased xxx xxxxx xxxx xxx xx xxx xx xxx xxxx xxxxxxxxx xx xx xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the applicant xx xxx xxxxxx xx a xxxxx xxx xxx suffered xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Please xxxxxx x point-based xxxxxxxxxx xx pain xxx xxxxxxxxx pursuant xx Xxxxxx No. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x treatment. Xxxx xxxxxxx report xxxx contain a xxxxx-xxxxx assessment of xxx pam suffered xxx a xxxxx-xxxxx xxxxxxxxxx of xxx xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx in xxxx xxxx only xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx xx relevant xxx xxx purposes xx Xxx no. 209/1997. According xx xxx xxxxxxxxxx xx §6, section 2 xx Act xx. 209/1997, xx financial xxxxxxx xxxx be xxxxxxxx xxxxxx xxx xxxxx assessment xx xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx may xxxxxx xxxx sum financial xxxxxxx xx xxx xxxxxx xx XXX 25,000 or an xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx you xxxxxx xx xxxxx xxx a xxxx xxx xxxxxxx, xxxxx xx xx xxxx xx fill xx xxxxx XXX - XxX.

This includes xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, hiring xx xxxxxxxxx to xxxx xxx xx xxx home or xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx paid xx xx insurance xxxxxxx. xx xxxx expenses xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx xxx not xxxx them xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx documents confirming xxxx xxxxx xx xxx application.

If xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx include x xxxxxxxxx xxxx his/her xxxxxxxx describing the xxxxxxx xxxxxx according xx §351 xx. xxx. xx Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx amended. lf xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx recent tax xxxxxx. xx xxx xxxxxxxxx is x xxxxxxx person xxx xx able xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx a xxxxxxxx xxxxxxxxxx xxx amount xx xxx retirement xxxxxxx. xx xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx situation xxxxxx xx xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx may xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x result of xxx xxxxxxxx xxx xx xxxxx X xxx x victim. X have xxx xxx xxxx compensated xxx the xxxx 1 have xxxxxxxx xx x xxxxxx xx the xxxxxxxx xxx.

X xxxxxx affirm xxxx I xxxx xxx lodged any xxxxx for xxxxxxxxx xxxxxxx xx xxx xxxxxxx claim for xxxxxxxxxxxx for the xxxx xxxxxxxx xx x result xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according to §12 xx Act Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx amended, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx as xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx xxx xxxxxx xx xxx financial xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx funding support. X xxxx acknowledge xxxx, xxxxx xxx xxxxx of xxx xxxx-xxxx period, X xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx waive xxx xxxxx'x xxxxx xxx xxx return xx xxx xxxxxxxx support, xxxxxx xxxx x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx standing, xxx xxxxx xxxxxx of xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx received.

I also xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx or xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx information for xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx an xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx xx xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx of xxx xxxxxxxxxxx for xxx xxxxxxxxx xx financial xxxxxxx pursuant xx Xxx No. 209/1997, xxx Ministry xx Xxxxxxx xxxxx confirm xxxxxxx xxx assign xx x serial xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall initiate xx investigation with xxx xxxxxx or x xxxxxxx authority xx xxx xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx months xxxx xxx xxxx xx xxx xxxxxxx of xxx application and xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, the Xxxxxxxx xxxxx xxxxxx xxxxxxx the xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx why xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx applicant xxxxx xx considered x victim as xxx Act Xx. 209/1997 Coll. xxxx xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx the commitment xx a crime. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of xxx xxx suffercd (not xxx weakening of xxxxxx xxxxxxxx), xxxxx xxxx xx at xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx be xxxxxxxxxx xx xx x xxxxxx if the xxxxxxxx xx x xxxxxx, spouse or xxxxx xx the xxxxxxxx xxx xxx xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx if xxx xxxxxxxx supported xx was xxxxxxxx xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx stipulates x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx the xxxx caused xx xxx crime. If xxxx xxxx xxxx xxx coincide xxxx xxx date of xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of the xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx of Justice xxxxxx xxxx an xxxxxxxxxxx xxx xxx xxxxxxxxx of financial xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Financial support xx xxxxxxx xxx xx a victim xxx xxx xxxxxxxx xxxxxx xxxx as x result xx xxx xxxxxxxxxx xx x xxxxx may xx xx the xxxx xx x xxxx sum xxxxxxxxx xx CZK 25,000 xx an xxxxxx xxxxx xx xxxx xxxxxx xx the xxxxx xx medical xxxxxxxxx as proved xx xxx xxxxxx, xxxxxxx by xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx amount xx xxxx xxxxxxx xxxx not xxxxxx XXX 150,000. Xx, xxxxx xxx provision xx support, xxx xxxxxx xxxxxx that xxx harm xxxxxxxx xxxxxxx the xxxxxx xxxxxxxx, the xxxxxx xxx receive additional xxxxxxx xx xx xxx amount xx XXX 150,000 if xx/xxx xxxxxxx for xx within the xxxxxxxxxxxxxx period xx xxxx (x.x., 1 xxxx from xxx xxxx on which xxx victim learned xx xxx xxxx xxxxxx xx the xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx will xx xxxxx into xxxxxxx.

- Xx xxxxxxxxxx xxx xx x xxxxxxxx xx x xxxxxx xxx has xxxx xx x xxxxxx xx the xxxxxxxxxx of x xxxxx (x xxxxxx, xxxxxx xx xxxxx xx the deceased xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx death or xxxxxxxxx xx or xxxxxxxx xx be xxxxxxxxx xx xxx xxxxxxxx) xxxxx be xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx total xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx victim xxxxx be reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. does xxx xxxxxxx the xxxxxxxxx xx xxx xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx liability xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx thus xx directed xx xxx insurers xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx of Xxxxxxx.

- Please bear xx mind xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Xxxxxx xxx applicant fail xx xxxxxxx any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x decision xx withhold any xxxxxxx as xxx Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, xxxxxxxxx xxx filing xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx in xxxx xxxx xxx applicant xxxxx xx xxxxxxx xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx xxx account xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx xxxxxx xx xxx xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx apply xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Justice may xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx the xxxxx xx the xxxx-xxxx xxxx, xxxxxxxx xxxx a waiver xx justified by xxx victim's xxxxxx xxxxxxxx, xxx total xxxxxx xx the xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx paid to xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však vyplnenie xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x xxxxxxxľxxx - xxxxx xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx zdraví, xxxxx xxxxx pozostalej xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx zákonného zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx základe dohody x plnej moci, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx kópiu xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx narodenia:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. V akom xxxxxx xxxx zomretá xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, osoba žijúca x spoločnej xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx listu x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx vyživovala pozostalú xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu rodič - dieťa xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx takou xxxxxxxx bude xxxxxxx xxxx x pod.)

IV. Xxxxxx, xx xxxxxxx xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx účtu.

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

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx o škode xxx xxôxxxxxxx dozvedela xx xxxxôx, xxxxxx xxxx a ako (xxxxxxxxx x lekárskej xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný x xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, xxxxxx zastupitelstvo, xxx), ktorý naposledy xxxxx xxxxxxx o xxxxxxxx xxxx. Xxxxxx xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx o xxx, x akom xxxxxx xx vec xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x žiadosti.

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

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x prihliadnutím xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku na xxxxxxx škody xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx VIII. Vyplňte, xx xxxxxxxľ xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx ste xxxxxxx osobou, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

1. Boli xxx xxxxxxx, manželom xxxxx xxxxxxxx osoby, xxxxx zomrela x xôxxxxxx xxxxxxxxx činu?

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

3. Xxxxxxxxxxx Xxx xxxx xxxxxxxxx xxxx xxxxxx, xx xxxx x xxxx xxxxxxx?

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

Xxxľx xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Xx. xx xx obeť považuje xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx smrti x xxx xxxx v xxxxxxxxxx xxxxx osoba, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Uveďte xxxxx, kedy xx xxxxxxxx liečenie, respektíve xxxx xx skončila xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx xxxx:

X xxxxxxxx sa musí xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx od xxxxxx, ktorý xx xxxxxxxxx. Tento lekársky xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx vytrpenej xxxxxxx a xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, že xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Zb. nemožno xxxxxxxxx' peňažnú pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Podľa xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť obete xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx sumy 25 000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx x peňažnú xxxxx xx xxxxx xxxxxxxxx čiastky, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx pomoc x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, a xxx. xxx xxxxxxxxxx, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ je x zamestnaneckom pomere, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Zb., xxxxxxxx xxxxx, v xxxxx neskorších xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx opis xxxxxxxxxx daňového xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, dokladom, xxxxx xôxx dokázať xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie x xxxxx starobného xôxxxxxx. X xxxxxxx, že x nejakého xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x nich xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, odkedy xxx xxxxxxxľ poberá, či xxxxxxx xx xxxxxx xxxx xx xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx poisťovne x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v dôsledku xxxxx xx zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx bol(a) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Škodu, xxxxx mi xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx na odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx neuplatnil(a) x žiadnom inom xxxxx ako x Xxxxxx (Slovenskej) republike.

Beriem xx xxxxxxx, xx xx xxxľx xxx. §12 zákona č. 209/1997 Xx., o xxxxxxxxxx xxxxxxxx pomoci xxxxxxx trestnej xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx zákonov, x xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, keď mi xxxxxxxx pomoc, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx dostal(a) xxx xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx vedomie, xx po uplynutí xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx práva xx xxxxxxxx poskytnutej xxxxxx, xx moja sociálna xxxxxxxx bude xxxx xxxxxx odôvodňovať, celková xxxxx škody, ktorú xx xxôxxxxxx a xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. c) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx na polícii xx na inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx xxxxx xxxxxxxx xx xxxxxx žiadosti x xxxxxxxxxx xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X zmysle zákona č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx v prípade, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx postačujúcou podmienkou xx xxxxxxxxx peňažnej xxxxxx xxxxx obeti xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (nie xxxx xxxxxxxx spoločenského xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Xx xxxx xx považuje xx xxxxx pozostalá xx obeti, ktorá x xôxxxxxx trestného xxxx xxxxxxx, xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx jeho smrti x xxx žila x domácnosti, alebo xxxxx, xxxxxx zomretý xxxxxxxxxx xxxxx bol xxxxxxx poskytovať výživu.

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

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, ktorá xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z xxxxxx xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - xx tom, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx xxx vzniknutá xxxxx je vyššia xxx tá, xxxxx xxxx podkladom xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx stanovenej týmto xxxxxxx jej xxxxx xxxxxxxxx xxxxx opäť, x xx až xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx na xxxxxxx, xxxxx už xxxx xxxxxxxxx.

- Fyzickej xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx a xxxxxxx x čase jeho xxxxx x ním xxxx x xxxxxxxxxx, xxxxx jej zomretý xxxxxxxxxx, či xxx xxxxxxx poskytovať xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Xx, x ak xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx čiastka sa xxx xxxxxx obeti xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx vozidiel, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, o poskytnutie xxxxxxxxx xxxxxxx. Len x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx je možné xxxxxx xxxxxxxxxxxx spravodlivosti x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, táto skutočnosť xôxx byť xôxxxxx xxxxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ xx do xxxxxxx xxxxx odo xxx poskytnutia xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx a xxx.) xx do xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx xxxx, xx mu xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx obete sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx xx vrátenie xxxxxxxxxxx peňažnej xxxxxx. Xx takýto postup xxôxxxxxxx sociálna xxxxxxxx xxxxx, xxxxxxx xxxxx xxxxx, ktorú xxx xxôxxxxxx, a výška xxxxxxx, xxxxx xxxx xxxxxxx.