Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Assessment xx Xxxxxxxxxxxx for xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx of Criminal Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx of xxxxxxxx xxxx xxx on xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx for xxxxxxxxx you with xxxxxxxx xxxxxxxxx xx xxxx current situation. Xxxxxxx, filling xx xxxx xxxxxxxxxxxxx xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx provision of xxxxxxxxx xxxxxxx pursuant xx Xxx no. 209/1997. Xxxxx xxx xxx your cooperation; xx xx highly xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx xxx xxxxxxxx xxxx of xxx xxxxxxxxx - x.x. xxx xxxxxx xx the criminal xxx who xxx xxxxxxxx bodily harm, xx xxx xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx of xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx address:

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

6. Xxxxx Number:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx represented by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx xxx/xxx parent) xx xx xxx xxxxx of x xxxxx of xxxxxxxx, xxxxxx xxxx in xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Permanent xx xxxxxxxxxx xxxxxxx:

Xx xxx representative xx xxxxxx xxx xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, please xxxx submit x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of a xxxxx of attorney (xxx contractual xxxxxxxxxxxxxx) xx x xxxx xx xxx birth xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) xx any xxxxx xxxxxxxxxx document.

III. Xx xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx consequenee xx xxx xxxxxxxxxx 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. Last xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx xxx applicant (x.x. xxxxxx, daughter, xx individual xxxxxx xx common household)

If xxx applicant xx x xxxxxxxx xx x person who xxxx in xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x xxxx xx xxx xxxxx certificate xxx xxx documents xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx xx obligation xx xxxxxxx the xxxxxxxx (in xxx xxxx xx a xxxxxx-xxxxx relationship, such xxxxxxxxx include xxxxx xxxxxxxxxxxx xx x xxxxx decision xx xxx xxxxxxxxxx xx xxxxxxx the dependent; xx xxx case xx married xxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx xxx xxxx xx xxxxx xxx crime xxx xxxxxxxxx xxx, xx xxx xxxxxx xxxxxxx xxxxx the xxxxxxxxxxxx xx the crime xx a xxxxx xxxx, please xxxx xxxxxxx the xxxx xxx xxx manner xx xxxxx xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx of xxx medical report).

VI. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, xxxxxx xxxxxxxxxx'x office, court) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx the xxxxxxxxx xxxxxx xx xxx xxxx xxxxxxx to xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx latest decision xx xxx abovementioned xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx stage xx xxx xxxxxxxxxx proceedings (x.x. xxxxxxxxxx on xxx xxxxxxxxxxxxxxx xx xxxxxxxx xxxxxxxxxxx, copy xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx otherwise).

Xxxxxxxxx xx xxx xxxxxxxxxx xx §8 of Xxx no. 209/1997, xxx xxxxxx xx xxxxxxxxx xxxxxxx may xx xxxxxxx or xxxxxxxx xxxxxxxxx xx xxxxxxx the xxxxxx xxx made xxx xx all xxxxx xxxxxxxx xx enforce x xxxxx for xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx any xxxxx person responsible xxx xxx harm xxxxxxxx. Do xxx xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx not xxxx xxxxxxxxxx.

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Xxxx in xxxx XxXx xx xxx xxxxxxxxx xx x survivor of xx individual who xxx died xx xxxxxxxxxxx xx xxx xxxxxxxxx crime.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx of the xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx xxxxxxx?

2. Xxx xxx xxxx xx x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx xxxxx xx xxx commitment xx xxx xxxxx?

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

4. Xx any xxxxx xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx xxxxxx, xx xxxxx to xxx.

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Xxxxxxxxx xx the provisions xx §2, section 2 xx Xxx xx. 209/1997, x xxxxxx who is x survivor xx x xxxxxx xxx xxxx xx consequence xx a xxxxxxxx xxx xx xxxxxxxxxx xx be x xxxxxx xx xx xx she xx x xxxxxx, spouse xx xxxxx xx xxx xxxxxxxx xxx xxxxx xxxx him xx her in xxx same household xx xx xxx xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx or xxx xxxxxxxx was xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx xxx applicant xx xxx xxxxxx xx x crime xxx has xxxxxxxx xxxxxx xxxx, xxxxxx xxxx in xxxxx XX - XIV.

Xxxxxx xxxxxx x point-based xxxxxxxxxx xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. Xxx xxxxxxxxxx xxxxxxxx xxxxxx xx xxxxxxxx from the xxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx contain x xxxxx-xxxxx xxxxxxxxxx of xxx pam suffered xxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x social xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx only xxx xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xx xxxxxxxx xxx the xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx provisions of §6, xxxxxxx 2 xx Xxx no. 209/1997, xx financial xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx xxxx xxxxxxxx xx xx least 100 xxxxxx.

Xxx xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx xx XXX 25,000 or xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx a xxxx xxx xxxxxxx, there xx no xxxx xx fill in xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx xxx xx xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., provided such xxxxx have xxx xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx xxx proved xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx confirming xxxx facts xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx is an xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx xxx/xxx xxxxxxxx describing xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx applicant is xxxx-xxxxxxxx, xxxx document xxxxx xx a xxxx xx xxx/xxx xxxx recent xxx xxxxxx. xx xxx xxxxxxxxx xx x xxxxxxx person xxx xx able to xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the amount xx the xxxxxxxxxx xxxxxxx. lf xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx situation xxxxxx xx xxxxxx, xx exceptional xxxxx xx affidavit may xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx xxx xx xxxxx I xxx x xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx xxx xxxx 1 xxxx suffered xx x xxxxxx xx xxx xxxxxxxx xxx.

X hereby affirm xxxx I xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x xxxxxx of xxx xxxxxxxx xxx xx xxx country xxxxx xxxx the Xxxxx Xxxxxxxx.

X acknowledge xxxx xxxxxxxxx xx §12 of Act Xx. 209/1997 Xxxx., xx the xxxxxxxxx xx financial support xxx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, I xx xxxxxxx xx xxxxxxxxx the Ministry xx Xxxxxxx xxx xxxxxx received xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx five xxxxx xxxx xxx xxxx of xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx xxxxxxxxxxx xxxx, xxxxx xxx xxxxx of the xxxx-xxxx xxxxxx, I xxx file xx xxxxxxxxxxx xxxxxx the Xxxxxxxx xx Xxxxxxx xx waive the xxxxx'x xxxxx for xxx return of xxx provided xxxxxxx, xxxxxx such x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx standing, xxx xxxxx xxxxxx of xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx consciously xxxxxx false or xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx purposes xx xxxxxxxxxxxxx gaining benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, section 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx offences xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx for xxx xxxxxxxxx of financial xxxxxxx pursuant to Xxx No. 209/1997, xxx Xxxxxxxx of Xxxxxxx shall xxxxxxx xxxxxxx xxx assign xx a xxxxxx xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx shall xxxxxxxx xx xxxxxxxxxxxxx with xxx police xx x similar xxxxxxxxx xx per xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx xxx xxxxxxxxx documents, xxx Xxxxxxxx xxxxx either xxxxxxx xxx support xx inform xxx xxxxxxxxx of xxx xxxxxxx xxx such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx applicant xxxxx xx considered x xxxxxx as xxx Act Xx. 209/1997 Xxxx. only xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx a xxxxxx xx the xxxxxxxxxx xx a xxxxx. X xxxxxxxxx but xxx xxx ohly xxxxxxxxx for the xxxxxx'x receipt of xxxxxxxx support shall xx xxx xxxxxx xx xxx point-based xxxxxxxxxx xx the xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx who xxx xxxx xx xxxxxxxxxxx xx x xxxxx xxxxx xx xxxxxxxxxx xx be a xxxxxx xx xxx xxxxxxxx xx a xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx his/her xxxxx xx if xxx xxxxxxxx xxxxxxxxx xx was required xx xxxxxxx the xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx provision xx xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx xxxx of 1 xxxx xxxx xxx date xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx caused by xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx date xx xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx shall xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx xxxxxxx of xxx consequences. Xxx Xxxxxxxx of Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx for xxx xxxxxxxxx of financial xxxxxxx received xxxxxxx xxxxx xxx lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied xxx xx x xxxxxx xxx has xxxxxxxx xxxxxx harm xx x result xx xxx commitment of x xxxxx xxx xx in the xxxx xx x xxxx sum xxxxxxxxx xx CZK 25,000 xx an amount xxxxx xx lost xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx by xxx xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx harm incurred. Xxx xxxxx xxxxxx xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx xxx provision xx xxxxxxx, xxx xxxxxx xxxxxx that xxx xxxx xxxxxxxx xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx of xxxx (i.e., 1 xxxx from xxx xxxx on which xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx paid will xx xxxxx into xxxxxxx.

- Xx individual xxx is a xxxxxxxx of a xxxxxx xxx has xxxx as a xxxxxx xx the xxxxxxxxxx of x xxxxx (a xxxxxx, xxxxxx or xxxxx xx xxx deceased xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx deceased xx xxx xxxx of xxx/xxx xxxxx or xxxxxxxxx by or xxxxxxxx xx be xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx xxxxxxxxx xx CZK 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx xxx xxxxxx xx victims xxxxxx xxxxx, xxx amount xxxxxxxx xxx xxxxxx xxxxx be xxxxxxx xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. xxxx xxx replace xxx xxxxxxxxx of xxx xxxxxxxxx liability of xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx to xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx matters xxxxxxx xx traffic accidents, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should thus xx directed xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx in isolated xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxx xxxx xxx Ministry of Xxxxxxx.

- Please xxxx xx mind xxxx xxx xxxxxxxxx documents xxx confirmations xxxxxxxx xxx the xxxxxxxxxx xxxxx must xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx fails to xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant xxxx xx deliver xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx even xxxxxx x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x xxxxxxxx xx withhold xxx xxxxxxx xx per Xxx No. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, prejudice xxx filing xx xxxxxxx xxxxxxxxxxx.

- Please xxxx xx xxxx xxxx xxx applicant xxxxx xx xxxxxxx xx return xxx xxxxxxxxx xxxxxx xxxxxxxx xx compensation xxx xxxx (xxxx the xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx xxx Ministry xx Justice xx xx the xxxxxx xx xxx support xxxxxxxx. Xxxx obligation xxxx xxx apply xx xx/xxx has xxx received any xxxxxxxxxxxx. If xx xxxxxxxxx xx the xxxxxx xx an xxxxxxxxxxx, xxx Ministry xx Xxxxxxx may xxxxx the state's xxxxx xx xxxxx xxx xxxxxx xx xxx xxxxxxxxx support xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx by xxx xxxxxx'x xxxxxx xxxxxxxx, xxx total xxxxxx xx xxx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxx to xxx xxxxxx.

Xxxxxx pán/pani/slečna

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

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X. Xxxxxx, xxxxxxx xxxxxxľxx xxxxxx xxxxx x žiadateľovi - xxxxx xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx xxxxxx, xxxxx osobe xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Telefón:

7. X-Xxxx:

8. Občianstvo:

II. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx rodičom) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx inú xxxxx, xxxx xx doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx zastúpení) xxxxx xxxxx xxxxxxx listu (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, xxxxxxx, xxxxxx, xx xxxxx o umretej xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. V akom xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, xxxxx xxxxxx x xxxxxxxxx domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx sa xxxx priložiť xxxxx xxxxxxxx listu x xxxxxxx, ktoré dokladajú xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx pozostalú xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx xôxxx x xxxxx list xxxxx rozhodnutie xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx xxxxxxx xxxx; v xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx trestného xxxx x ak xx xxxx x xxxxx xxx spôsobenej xxxxxxxxx xx neskôr, xxxxxx xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Označte xxxxx xxxxx x xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, xxxxxx zastupitelstvo, xxx), xxxxx xxxxxxxxx xxxxx konanie x xxxxxxxx čine. Xxxxxx xx xxxxxxx značku, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného v xxxxxxxx konaní, xxxxx xxxx predstavu x xxx, v xxxx xxxxxx xx xxx xxxxxxxx (napr. xxxxxxxxx x odložení xxxxxxxxx xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), pripojte xx x xxxxxxxx.

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

Xxxľx xxxxxxxxxxx §8 zákona č. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx s xxxxxxxxxxxxx xx xx, či xxxx xxxxxxx xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx na xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

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

XXXX. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 xxxxxx č. 209/1997 Xx., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, ak xx Xxx xxxxx xxxxxxxxxxx známe.

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

2. Xxxx xxx s xxxxxx xxxxxxxxx činu xxxx xxxxxxxxx xxxxxxxxx xxxx v xxxxxxxxx xxxxxxxxxx?

3. Xxxxxxxxxxx Xxx xxxx trestného xxxx xxxxxx, či bola x xxxx xxxxxxx?

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

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť považuje xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, manželom alebo xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XXX. Vyplňte, xx sa žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx ujma xx zdraví.

IX. Xxxxxx xxxxx, xxxx xx xxxxxxxx xxxxxxxx, respektíve xxxx xx xxxxxxxx xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx bodového xxxxxxxxxxx xx bolesť xxxx:

X xxxxxxxx xx musí xxxxxxxx xxxxxx xxxxxxxxxxx xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx bude obsahovať xxxxxx hodnotenie vytrpenej xxxxxxx a xxxxxx xxxxxxxxxx xxxxxxxx spoločenského xxxxxxxxxx. Pripomíname, xx xxx xxxxx zákona č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. nemožno xxxxxxxxx' peňažnú xxxxx, xx bodové xxxxxxxxxxx xxxxxxxxx bolesti nedosiahne xxxxxxxx 100 xxxxx.

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

Podľa xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx xxxxxxx obete xxxxx xxxxxxxxx xxxxxxx xxxxx vo xxxxx xxxxxxxxx xxxx 25 000.- Xx, xxxxx vo xxxxx zodpovedajúcej xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx o xxxxxxx xxxxx xx xxxxx xxxxxxxxx xxxxxxx, nemusíte xx vyplňovať xxxx XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx na xxxxx x xxxxxxxxxx či xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, a xxx. pod xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Tu xxxxxxx xxxxxxx xx xxxxx doložiť, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx zreteľ.

XIII. Xxxxxxx xxxxxxxxx pomery xxxxxxxľx xxxx x po xxxxxx xxxx na xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx žiadateľ je x zamestnaneckom xxxxxx, xôxxx x xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx samostatne zárobkovo xxxxxx, xxxxx xxxxxxxx xxxx napríklad xxxx xxxxxxxxxx daňového priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx môže dokázať xxxxxxxx xxxxxxxx situáciu, xxxx xxxxxxxxxx x xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, že x xxxxxxxx xxxxxxxxx xôxxxx nemožno doložiť xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx xxxxxxx xx možné xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx vyhlásením.

XIV. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, či xxxxxxx xx xxxxxx xxxx na xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx potvrdenie xxxxxxxxxxxxľx alebo xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X prípade, xx v xôxxxxxx xxxxx xx zdraví xxôxxxxxxx trestným xxxxx Xxx xxxxxxxx invalidný xôxxxxxx, uveďte a xxxxxxx xxxx výšku.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx xxxxx, ktorého xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx zhoršila. Xxxxx, xxxxx xx takto xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx na peňažnú xxxxx či xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx som xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx ako x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx xxxxxxx, že xx podľa xxx. §12 xxxxxx x. 209/1997 Zb., o xxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx xxxxx odo xxx, xxx xx xxxxxxxx pomoc, odviesť xx účet Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx xxxxx, a xx až do xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx na vedomie, xx xx xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx xx x mene xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja xxxxxxxx xxxxxxxx bude xxxx xxxxxx odôvodňovať, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx náhrady, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, xx xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx výhody, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 písm. x) xxxxxx č. 200/1990 Xx., x priestupkoch, x znení xxxxxxxxxx xxxxxxxxx.

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xxxxxx žiadateľa alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx xxxxxxxxx po xxxxxxx xxxxxxxx o xxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx xx inom xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch mesiacov xx xxxxxx žiadosti x predložení potrebných xxxxxxxx xxx xxxxx xxxxxxxx alebo xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx poskynúť.

- X xxxxxx zákona č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx xx x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx poškodenie xxxxxxx. Nevyhnutnou, xxx xxxx xxxxxxxxxxxx podmienkou xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx bodového xxxxxxxxxxx bolesti (nie xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Xx xxxx sa xxxxxxxx xx osoba xxxxxxxxx xx obeti, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 roka xxx xxx, keď xx xxxx xxxxxxxxx x xxxxx spôsobenej xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx dokazuje xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx vyhovieť žiadostiam x xxxxxxxxxxx peňažnej xxxxxx, ktoré xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx xx žiadosť xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25 000.- Xx xxxxx xx xxxxx, ktorá predstavuje xxxxxxxxxx xxxxxx xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; pomoc vo xxxxxx súčte nesmie xxxxxxxxxx sumu 150 000.- Xx. Xx xxxx - xx tom, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx je xxxxxx xxx xx, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx žiadosť x xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx xxxxxxxxxx na xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Fyzickej xxxxx, ktorá je xxxxxxxxxx xx obeti, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx jeho xxxxx x ním xxxx x domácnosti, xxxxx jej zomretý xxxxxxxxxx, xx xxx xxxxxxx poskytovať výživu), xx xxxxxxxx xxxxxxx xxxxx v paušálnej xxxx 150 000.- Xx; xxxxx vo xxxxxx xxxxx xxxxxx presiahnuť xxxx 450&xxxx;000.- Xx, x xx xx xxxxx obetí xxxx xxx tri xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx obeti xxxxxxxxx xxxxx.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x xxxxxxxxxxxxx xx xxxxxxxxx výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx x xxxxxxx ani xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ xx do xxxxxxx xxxxx xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx do xxxxx xxxxxxxxxxx pomoci. Xxxx povinnosť xxxx, xx mu škodu xxxxxxxxxx. Xx základe xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx na vrátenie xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto postup xxôxxxxxxx xxxxxxxx situácia xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.