Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx xxx xxx Xxxxxxxxx xx Xxxxxxxxx Support to Xxxxxxx xx Xxxxxxxx Xxxx pursuant to Xxx Xx. 209/1997 Xxxx., on xxx xxxxxxxxx xx fulancial xxxxxxx xx xxx xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx questions in xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx questionnaire xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx application xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Act xx. 209/1997. Xxxxx xxx xxx your xxxxxxxxxxx; xx is xxxxxx xxxxxxxxxxx.

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X. Please legibly xxxx xx xxx xxxxxxxx data of xxx xxxxxxxxx - x.x. xxx victim xx the xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx xxx survivor xx a person xxx has xxxx xx xxxxxxxxxxx of xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx representation (xxx xxxxxxxx, a xxxxx child represented xx xxx/xxx xxxxxx) xx xx xxx xxxxx of a xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx data xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx registered xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx of x xxxxx of xxxxxxxx (xxx xxxxxxxxxxx representation) xx x copy xx the xxxxx xxxxxxxxxxx (for xxxxxxxxx xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx document.

III. Xx the xxxxxxxxx xx x survivor xx a xxxxxx xxx has xxxx xx xxxxxxxxxxx of xxx xxxxxxxxxx criminal xxx, please fill xx xxx xxxxxxxx xxxx xx the xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Xxxx of xxxxx:

5. Last xxxxxxxxx xxxxxxx:

6. Nationality:

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

Xx xxx xxxxxxxxx xx x survivor xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, xxxxxx xxxxxx x xxxx xx xxx death certificate xxx xxx xxxxxxxxx xxxxxxx xxxx the xxxxxxxx supported or xxx an obligation xx xxxxxxx xxx xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx xx x xxxxx decision on xxx xxxxxxxxxx xx xxxxxxx the dependent; xx the xxxx xx xxxxxxx couples, xxxxxx attach x xxxxxxxx certificate).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx xxxxx was xxxxxxxxx and, xx xxx xxxxxx learned xxxxx xxx xxxxxxxxxxxx xx xxx xxxxx xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx xxx xxxx xxx xxx manner xx xxxxx xxx xxxxxx xxxxxxx of xxxx xxxxxxxxxxxx (e.g., xxx xxxx xx xxx medical xxxxxx).

XX. Xxxxxx specify the xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, public xxxxxxxxxx'x office, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx the reference xxxxxx of xxx xxxx xxxxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, please attach xxx latest decision xx the abovementioned xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx xxxxx of xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, copy xx the indictment, xxxxxxxxx - xxxxx xx otherwise).

Xxxxxxxxx xx xxx provisions xx §8 xx Xxx no. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx made xxx xx all xxxxx xxxxxxxx xx xxxxxxx x xxxxx for xxxxxxxxxxxx against xxx xxxxxxxx xx xxx xxxxx person xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx in xxxx xxxx xx xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx VlIl xx xxx applicant xx x survivor xx xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx xxx a xxxxx, xxxxxx xx xxxxx of the xxxxxx xxx xxxx xx consequence xx xxx xxxxxxxx xxxxxxx?

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

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

4. Xx xxx xxxxx xxxxxxx xxxx xxx xxxxxxxxxx described in xxxxxxx 1 xx 3? Xxxxxx xxxx xxxxx number, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 of Act xx. 209/1997, a xxxxxx who xx x survivor xx x victim xxx xxxx in xxxxxxxxxxx xx a criminal xxx is xxxxxxxxxx xx xx x xxxxxx xx xx xx xxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxxxx with him xx xxx xx xxx same xxxxxxxxx xx xx xxx xxxxxx was x xxxxxxxxx of xxx xxxxxxxx or xxx xxxxxxxx was xxxxxxxx xx xxxxxxx the xxxxxx.

Xx the xxxxxxxxx xx the victim xx a xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx in xxxxx XX - XXX.

Please attach x point-based xxxxxxxxxx xx xxxx and xxxxxxxxx xxxxxxxx to Xxxxxx Xx. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx should be xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx victim's xxxxxxxxx. Xxxx medical xxxxxx xxxx contain x xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx xx the xxxxxxxx xx the xxxxxx'x social position. Xxxxxx xxxx xx xxxx xxxx xxxx xxx point-based assessment xx xxx xxx xxxxxxxx is relevant xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act no. 209/1997, no xxxxxxxxx xxxxxxx xxxx be xxxxxxxx xxxxxx the xxxxx assessment of xxx xxxx xxxxxxxx xx xx xxxxx 100 xxxxxx.

The xxxxxx xxx obtain xxxx xxx xxxxxxxxx xxxxxxx in xxx xxxxxx of XXX 25,000 xx an xxxxxx xxxxx xx xxx proved xxxxx xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx a xx Xxx Xx. 209/1997 Xxxx.). lf xxx xxxxxx to xxxxx xxx x xxxx xxx xxxxxxx, there xx xx need xx fill xx xxxxx XXX - XxX.

This xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx to xxxx xxx in xxx xxxx xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx transportation xxxxx xxx., provided xxxx xxxxx xxxx xxx xxxx paid xx xx insurance company. xx xxxx xxxxxxxx xxx not xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may not xxxx them into xxxxxxxxxxxxx.

Xxxxxx attach xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx to xxx application.

If the xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx include a xxxxxxxxx xxxx xxx/xxx xxxxxxxx describing xxx xxxxxxx salary according xx §351 xx. xxx. xx Xxx xx. 262/2006, the Xxxxx Labour Xxxx, xx amended. lf xxx xxxxxxxxx is xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx xx his/her xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx is x xxxxxxx person xxx xx xxxx xx xxxxx xxx/xxx xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx a document xxxxxxxxxx the amount xx xxx xxxxxxxxxx xxxxxxx. lf xxx xxx xxxxxx the xxxxxxxxx'x income xxxxxxxxx xxxxxx xx xxxxxx, xx xxxxxxxxxxx cases xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx act xx xxxxx X xxx a victim. X xxxx not 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 result xx xxx xxxxxxxx xxx xx any country xxxxx xxxx xxx Xxxxx Republic.

I xxxxxxxxxxx xxxx according xx §12 of Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx support xxx xxx victims xx criminal xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx the Ministry xx Xxxxxxx any xxxxxx xxxxxxxx as xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx funding support. X xxxx xxxxxxxxxxx xxxx, after the xxxxx xx xxx xxxx-xxxx xxxxxx, I xxx file an xxxxxxxxxxx xxxxxx the Xxxxxxxx xx Xxxxxxx xx xxxxx xxx xxxxx'x claim for xxx xxxxxx xx xxx xxxxxxxx support, xxxxxx such x xxxxxx be xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, xxx xxxxx extent of xxxx suffered xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx benefits xxx xxxxxxxxx xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx x) of Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx amended.

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Signature of xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx the xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Ministry xx Xxxxxxx xxxxx xxxxxxx xxxxxxx and xxxxxx xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx shall xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx xxxxxx xx x xxxxxxx xxxxxxxxx xx per xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx xxxxxx from xxx date xx xxx receipt xx xxx xxxxxxxxxxx xxx xxxxxxxxxx of the xxxxxxxxx documents, the Xxxxxxxx shall xxxxxx xxxxxxx the support xx xxxxxx xxx xxxxxxxxx of the xxxxxxx why xxxx xxxxxxx xxx been xxxxxxxx.

- Xxx applicant xxxxx be considered x victim as xxx Xxx Xx. 209/1997 Xxxx. xxxx xx xx/xxx xxx xxxxxxxx bodily xxxx xx a xxxxxx xx the xxxxxxxxxx xx a xxxxx. X necessary but xxx xxx ohly xxxxxxxxx xxx xxx xxxxxx'x receipt of xxxxxxxx xxxxxxx xxxxx xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx (not xxx xxxxxxxxx of xxxxxx xxxxxxxx), which xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx of x xxxxxx xxx xxx xxxx xx consequence xx a crime xxxxx xx xxxxxxxxxx xx xx x xxxxxx xx xxx xxxxxxxx xx x xxxxxx, xxxxxx or xxxxx xx the xxxxxxxx xxx xxx xxxxxxxx shared a xxxxxxxxx xxxx the xxxxxxxx at the xxxx xx xxx/xxx xxxxx xx if xxx deceased supported xx xxx xxxxxxxx xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxxxxxx of criminal xxxx stipulates x xxxxxxxxxx xxxx xx 1 xxxx xxxx xxx xxxx on xxxxx the xxxxxx xxxxxxx of the xxxx caused by xxx xxxxx. If xxxx xxxx xxxx xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx of xxx xxxxx, xxx xxxxxx xxxxx xxxxxxx xxxxxxxx of xxx xxxx on xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Justice xxxxxx xxxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx received xxxxxxx xxxxx the lapse xx xxx xxxxxxxxxxxxxx xxxxxx.

- Financial xxxxxxx xx applied xxx xx x victim xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x crime xxx xx in the xxxx of x xxxx sum xxxxxxxxx xx XXX 25,000 xx xx amount xxxxx xx xxxx xxxxxx xx xxx xxxxx of medical xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx xx xxx xxxxxx xxxxxxxxxx paid xx the victim xx compensation xxx xxx xxxx xxxxxxxx. Xxx total amount xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx the xxxxxxxxx xx support, xxx xxxxxx proves xxxx xxx harm xxxxxxxx xxxxxxx the amount xxxxxxxx, xxx victim xxx receive additional xxxxxxx xx to xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx within xxx xxxxxxxxxxxxxx period xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); in xxxx xxxx, xxx amounts xxxxxxx xxxx xxxx xx taken xxxx xxxxxxx.

- Xx individual xxx xx x xxxxxxxx xx x xxxxxx who xxx xxxx xx x xxxxxx xx the xxxxxxxxxx xx a xxxxx (a xxxxxx, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx xx xxx time xx xxx/xxx xxxxx xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx financial xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx xxxxxx xxxxxxxx xxx victim xxxxx xx xxxxxxx xxxxxxxxxxx.

- Act Xx. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx liability of xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx to xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx circumstances, xxx an xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xx filed with xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx xxxx xx mind that xxx xxxxxxxxx xxxxxxxxx xxx confirmations xxxxxxxx xxx xxx respective xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. If xxx xxxxxxxxx fails xx xx xx, the Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx application. Xxxxxx xxx xxxxxxxxx fail xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx deadline, xxxx fact xxx xxxxxxx x decision xx xxxxxxxx xxx xxxxxxx xx xxx Xxx No. 209/1997 Xxxx. This xxxxx xxx, xxxxxxx, prejudice xxx filing xx xxxxxxx application.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx return xxx xxxxxxxxx amount xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (from xxx xxxxxxxx, insurers etc.) xx xxx account xx the Xxxxxxxx xx Justice xx xx xxx xxxxxx xx the xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx not xxxxx xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. If xx xxxxxxxxx xx xxx xxxxxx in xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxxxx xxx xxxxx'x xxxxx xx xxxxx xxx xxxxxx xx xxx financial xxxxxxx xxxxxxxx after xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx xx xxx xxxx xxxxxxxx xxx xxx amount of xxxxxxxxxxxx paid to xxx victim.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, x ktorej xx nachádzate, sme xxxxxx Vás obťažovať xxxxxxxxxxxx otázkami. V xxxxxx xxxxxxxx posúdenia Xxxxx xxxxxxxx x xxxxxxxxxxx peňažnej pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, xxxxx xx xxxxx ceníme.

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I. Xxxxxx, xxxxxxx xxxxxxľxx osobné xxxxx o xxxxxxxľxxx - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx xx zdraví, xxxxx osobe xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx trvalého xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx iná xxxxx (zástupca) na xxxxxxx zákonného xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) alebo xx xxxxxxx dohody x plnej moci, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) alebo xxxxx rodného xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) alebo inú xxxxxxx xxxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx činu k xxxxx žiadateľa (xxxx, xxxxx, osoba xxxxxx x spoločnej xxxxxxxxxx):

Xx xx žiadateľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx zomrela, x xxxxxxxx xx xxxx priložiť kópia xxxxxxxx listu x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, že umretá xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx mala xxxxxxxxx xx vyživovať (xx vzťahu xxxxx - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x vyživovacej xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, xx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; v xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx účtu.

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

Uveďte dátum xxxxxxxxx xxxxxxxxx xxxx x xx xx xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx a ako (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx xxxxxx (xxxxxxxxx xxxxx, štátne zastupitelstvo, xxx), ktorý naposledy xxxxx xxxxxxx x xxxxxxxx xxxx. Xxxxxx xx spisovú xxxxxx, xxx ktorou prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného v xxxxxxxx xxxxxx, xxxxx xxxx predstavu x xxx, v akom xxxxxx sa xxx xxxxxxxx (napr. xxxxxxxxx x odložení trestného xxxxxxxx, xxxx obžaloby, xxxxxxxx - i xxxxxxxxxxxxx), xxxxxxxx xx x xxxxxxxx.

XXX. Uveďte, xxxx spôsobom xxx xxxxxxxxx xxxxx na xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx škodu.

Podľa xxxxxxxxxxx §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx sa môže xxxxxx alebo sa xxxxxxxx x prihliadnutím xx xx, či xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx alebo inej xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx xxxxxxxxxxx, ak xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, či xxx xxxxxxx osobou, ktorá xxľxx podmienky uvedené x §2 xxxx. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx podmienky, xx xx Vám xxxxx xxxxxxxxxxx známe.

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

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

3. Poskytovala Vám xxxx trestného činu xxxxxx, xx bola x tomu xxxxxxx?

4. Xxľxxxx další osoby xxxxxxxxxxx podmienky 1 xx 3? Uveďte xxx xxxxx, xx Xxx xx známy.

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx č. 209/1997 Xx. xx xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx trestného činu xxxxxxx, xx xx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx s xxx žila x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx xxx povinný xxxxxxxxxx xxxxxx.

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Xxxx IX. xx XXX. Vyplňte, xx xx žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx xxxx xx xxxxxx.

XX. Xxxxxx xxxxx, kedy sa xxxxxxxx liečenie, xxxxxxxxxx xxxx xx skončila xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť xxxx:

X xxxxxxxx sa xxxx xxxxxxxx xxxxxx ohodnotenie xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, ktorý ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx bude xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx a xxxxxx xxxxxxxxxx xxxxxxxx spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. je relevantné xxx bodové xxxxxxxxxxx xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x poskytnutie xxxxxxxx xxxxxx vo výške xxxxxxxxx xxxxxxx 25 000.- Xx xxxxx či xxxxxxxx xxxxx xxxxxx xxxxxxx x xxxxxxxx xx liečenie.

Podľa ustanovenia §7 xxxx. 1 xxxx. x) zákona x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx xxxxxxxxx peňažnú xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx liečenie x xxxxxx zárobku. Xx xx xxxxxxxxxx xxxxxx x xxxxxxx xxxxx vo výške xxxxxxxxx xxxxxxx, nemusíte xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x náklady xx lieky, xxxxxxxxxxxx xxxôxxx, náklady xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx na xxxxx x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, a xxx. pod xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, inak xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx x xx xxxxxx xxxx na xxxxxx xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx xxxxxxxľ je x xxxxxxxxxxxxxx xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, x xxxxx neskorších xxxxxxxxx. Xx je xxxxxxxľ xxxxxx samostatne xxxxxxxxx xxxxxx, xxxxx listinou xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx môže xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie x xxxxx xxxxxxxxxx xôxxxxxx. X prípade, xx x nejakého xxxxxxxxx xôxxxx xxxxxxx doložiť xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx dôchodku) x xxxx, xxxxxx ich xxxxxxxľ poberá, xx xxxxxxx po vzniku xxxx xx xxxxxx, xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo poisťovne x výške xxxxxxxxxxxx xxxxx. X xxxxxxx, xx v xôxxxxxx xxxxx xx zdraví xxôxxxxxxx trestným činom Xxx priznali xxxxxxxxx xôxxxxxx, uveďte a xxxxxxx xxxx výšku.

Xxxx majetkové pomery xx také, xx xxxxxxxx činom, xxxxxxx xxx xxx(x) obeťou, xx moja sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ nebola xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx odškodnenie xxxx xxôxxxxxxx trestným xxxxx som neuplatnil(a) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx xxxľx xxx. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx činnosti x o zmene x x xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx do xxxxxxx xxxxx odo xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, ktoré xxx xxxxxx(x) ako xxxxxxx xxxxx, x xx až xx xxxxx poskytnutej xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, xxx xx x mene xxxxx xxxxxx xxxxx na xxxxxxxx poskytnutej xxxxxx, xx moja xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx a xxxxx náhrady, xxxxx xxx dostal(a).

Beriem xxxx xx xxxxxxx, že xxxxxxxxx uvedením xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx jeho zatajením xx účelom získania xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť xxxxxxxxxx xxxľx §21 odst. 1 xxxx. c) xxxxxx č. 200/1990 Xx., x priestupkoch, x znení neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx republiky xx xxxxxxx žiadosti x xxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Potom xxxx xxxxxxxxxx xx xxxxxxx xx xx inom xxxxxxxx orgáne xxxľx xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx xxxxxxxxxx xxxxxxxx buď xxxxx xxxxxxxx alebo xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx za xxxx xxx v xxxxxxx, xx xx v xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx poškodenie xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx bodového xxxxxxxxxxx xxxxxxx (nie xxxx xxxxxxxx spoločenského xxxxxxxxxx) dosahujúceho aspoň 100 bodov. Xx xxxx sa xxxxxxxx xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x dôsledku trestného xxxx xxxxxxx, xx xxxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x ním xxxx x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx xxxxxx xxxxxxx trestnej činnosti xxxxxxxxx prekluzívnu (prepadnú) xxxx 1 xxxx xxx xxx, keď xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx dňom už xxx je xxx xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx okamžik, xxxx sa xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx vyhovieť žiadostiam x xxxxxxxxxxx peňažnej xxxxxx, xxxxx xx xxxxxxxx po xxxxxxxx xxxxxxxxxx xxxxxx.

- Pomoc xx xx xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, poskytne v xxxxxxxxx sume 25 000.- Xx alebo xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx xx xxxxxxx, preukázané náklady xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx čiastok, xxxxx xxxx z titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx sumu 150 000.- Xx. Xx obeť - xx tom, xxx xxx poskytli xxxxx - xxxxxxxx, xx jej xxxxxxxxx xxxxx je xxxxxx xxx tá, xxxxx xxxx podkladom xx xxxxxxxxxxx pomoci, na xxx žiadosť v xxxxxx xxxxxxxxxx týmto xxxxxxx xxx xxxxx xxxxxxxxx xxxxx opäť, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx na xxxxxxx, xxxxx už xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx xx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x zároveň x xxxx xxxx xxxxx s ním xxxx v xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx poskytovať výživu), xx xxxxxxxx peňažná xxxxx x paušálnej xxxx 150&xxxx;000.- Xx; xxxxx vo svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x ak xx xxxxx xxxxx xxxx xxx tri xxxxx, xxxxxxxxxxx čiastka xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti vykonávateľa xxxxxxxxxx vozidiel, xx xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx plnenia. Len x celkom ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne xxxxxxxxx xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x xxxxxxxxxxx peňažnej xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, na xxxxx odkazujeme xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Xx xxxxxx potvrdenia x xxxxxxx xxx xxxxxxxxx xxxxxx, táto xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx do xxxxxxx rokov xxx xxx xxxxxxxxxxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx dostal xxx xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Na základe xxxxxxxx obete xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx xxxx xxxxx xxxxx xx vrátenie xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx výška xxxxx, ktorú xxx xxôxxxxxx, a výška xxxxxxx, ktorú obeť xxxxxxx.