Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx the Xxxxxxxxxx xx Applications xxx xxx Provision xx Xxxxxxxxx Xxxxxxx to Xxxxxxx of Xxxxxxxx Xxxx xxxxxxxx to Xxx No. 209/1997 Xxxx., xx the xxxxxxxxx of xxxxxxxxx xxxxxxx xx xxx xxxxxxx of xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx xx xxxx current xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx for xxx xxxxx xxxxxxxxxx xx xxxx application xxx xxx provision xx xxxxxxxxx support pursuant xx Act no. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx xx highly xxxxxxxxxxx.

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X. Please legibly xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx xxx xxxxxxxx xxx who xxx xxxxxxxx bodily harm, xx xxx survivor xx x xxxxxx xxx has died xx consequence xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx xxxxxxx:

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

6. Xxxxx Xxxxxx:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx person ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx his/her xxxxxx) xx xx the xxxxx of x xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Permanent xx xxxxxxxxxx xxxxxxx:

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

III. Xx the applicant xx x xxxxxxxx xx x person xxx has died xx consequenee xx xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Surname:

2. Given xxxx:

3. Date xx xxxxx:

4. Xxxx of xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

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

Xx xxx applicant xx x survivor xx x xxxxxx who xxxx in xxxxxxxxxxx xx xxx xxxxxxxx xxx, please attach x xxxx of xxx xxxxx xxxxxxxxxxx xxx any xxxxxxxxx xxxxxxx xxxx the xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx xxx xxxx of a xxxxxx-xxxxx relationship, xxxx xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx xx x xxxxx xxxxxxxx on xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx the xxxx xx xxxxxxx couples, xxxxxx attach x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx xx which xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx the consequences xx xxx crime xx x later xxxx, xxxxxx xxxx xxxxxxx xxx date xxx xxx xxxxxx xx xxxxx the xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx xxxxxxx report).

VI. Xxxxxx xxxxxxx xxx xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx recently xxxxxxxxx xxxxxxxx proceedings. Xxxxx the xxxxxxxxx xxxxxx xx xxx xxxx xxxxxxx xx xxx respective proceedings.

If xxxxxxxxx, please xxxxxx xxx latest decision xx the xxxxxxxxxxxxxx xxxxxxxx xxxxxxx authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, copy xx xxx indictment, xxxxxxxxx - final xx otherwise).

According xx xxx provisions xx §8 of Xxx xx. 209/1997, xxx xxxxxx of xxxxxxxxx xxxxxxx xxx xx reduced xx xxxxxxxx xxxxxxxxx on xxxxxxx xxx xxxxxx xxx xxxx xxx xx xxx xxxxx xxxxxxxx xx xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx or xxx xxxxx xxxxxx xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx in this xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx if xxx xxxxxxxxx is x survivor xx xx individual xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

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

2. Xxx you xxxx xx a common xxxxxxxxx with the xxxxxxxx xxxxxx xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

3. Xxxx you a xxxxxxxxx xx xxx xxxxxx xx xxx xxx xxxxxxxx obliged xx xxxxxxx you?

4. Xx any xxxxx xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx in xxxxxxx 1 xx 3? Please give xxxxx xxxxxx, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, xxxxxxx 2 xx Xxx xx. 209/1997, x xxxxxx who xx x xxxxxxxx of x xxxxxx who xxxx xx xxxxxxxxxxx xx x criminal xxx is xxxxxxxxxx xx xx x xxxxxx xx xx xx she xx x xxxxxx, xxxxxx xx xxxxx xx xxx deceased and xxxxx xxxx him xx xxx xx xxx xxxx xxxxxxxxx xx xx xxx xxxxxx xxx a xxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxx was required xx support xxx xxxxxx.

Xx xxx xxxxxxxxx xx the xxxxxx xx x crime xxx xxx suffered xxxxxx xxxx, xxxxxx xxxx xx xxxxx XX - XXX.

Xxxxxx xxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxxx and xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx from xxx xxxxxxxxx xxxxxxxxxxx xxx xxx victim's xxxxxxxxx. Xxxx medical report xxxx xxxxxxx x xxxxx-xxxxx assessment xx xxx pam suffered xxx x point-based xxxxxxxxxx of the xxxxxxxx xx xxx xxxxxx'x social xxxxxxxx. Xxxxxx xxxx in xxxx xxxx xxxx xxx xxxxx-xxxxx xxxxxxxxxx xx the pam xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx no. 209/1997. Xxxxxxxxx to xxx provisions xx §6, xxxxxxx 2 xx Act no. 209/1997, no xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx the xxxxx xxxxxxxxxx xx xxx xxxx suffered xx xx xxxxx 100 xxxxxx.

Xxx xxxxxx may xxxxxx xxxx xxx financial xxxxxxx xx xxx xxxxxx xx CZK 25,000 or xx xxxxxx equal xx xxx proved xxxxx xx medical xxxxxxxxx xxx lost income (§7, section 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx xx apply xxx x xxxx xxx xxxxxxx, xxxxx xx xx xxxx xx xxxx in xxxxx XXX - XxX.

Xxxx includes xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx medical treatment, xxxxxxxxx transportation xxxxx xxx., provided xxxx xxxxx xxxx xxx xxxx paid xx xx insurance company. xx xxxx xxxxxxxx xxx not proved xx xxxxxxxxxxx xxxxxxxx, xxx Ministry of Xxxxxxx xxx xxx xxxx them xxxx xxxxxxxxxxxxx.

Please xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx include a xxxxxxxxx from his/her xxxxxxxx xxxxxxxxxx xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. xx Act xx. 262/2006, xxx Xxxxx Labour Code, xx xxxxxxx. xx xxx applicant is xxxx-xxxxxxxx, xxxx document xxxxx xx x xxxx of xxx/xxx xxxx recent xxx xxxxxx. lf xxx xxxxxxxxx xx a xxxxxxx xxxxxx who xx xxxx to xxxxx xxx/xxx impaired xxxxxx standing, please xxxxxx x xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx reason xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx xxxxxx, xx xxxxxxxxxxx xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx of xxx xxxxxxxx act xx which X xxx x xxxxxx. X have not xxx xxxx compensated xxx xxx xxxx 1 have xxxxxxxx xx x result xx xxx xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx xxxxxx any xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx for xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx xxxxxxxx act xx xxx xxxxxxx xxxxx xxxx the Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according to §12 xx Act Xx. 209/1997 Xxxx., xx the provision xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx xx xxxxxxxx xxxxxxx other xxxx, xx xxxxxxx, I xx obliged xx xxxxxxxxx the Ministry xx Xxxxxxx xxx xxxxxx received xx xxxxxxxxxxxx for the xxxx xxxxxxxx, xx xx xxx amount xx xxx financial xxxxxxx, xxxxxx five xxxxx xxxx xxx xxxx xx receiving xxx funding support. X also acknowledge xxxx, xxxxx the xxxxx of the xxxx-xxxx xxxxxx, I xxx xxxx xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x xxxxx for xxx xxxxxx xx xxx provided xxxxxxx, xxxxxx such a xxxxxx xx xxxx xxxxxxxx xx my xxxxxx xxxxxxxx, xxx xxxxx extent xx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X also xxxxxxxxxxx xxxx consciously xxxxxx xxxxx or xxxxxxxxxx information or xxxxxxxxxxx information xxx xxx xxxxxxxx xx xxxxxxxxxxxxx gaining benefits xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, xxxxxxx 1, xxxxxx x) of Xxx no. 200/1990 Xxxx., xx offences xx amended.

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Signature xx xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx xx the xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx No. 209/1997, xxx Ministry of Xxxxxxx xxxxx confirm xxxxxxx xxx assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx xxxxxx or x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxx xxxx. Within xxxxx xxxxxx from xxx date xx xxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxxxxxxxxx xx the xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall either xxxxxxx the xxxxxxx xx xxxxxx the xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx has xxxx xxxxxxxx.

- Xxx xxxxxxxxx xxxxx xx considered x victim as xxx Xxx Xx. 209/1997 Coll. xxxx xx he/she has xxxxxxxx xxxxxx xxxx xx x xxxxxx xx the commitment xx x crime. X xxxxxxxxx xxx xxx xxx ohly xxxxxxxxx xxx xxx xxxxxx'x xxxxxxx of xxxxxxxx support shall xx the amount xx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), which xxxx xx at xxxxx 100 xxxxxx. Xxxxxxxxx of a xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx be considered xx xx x xxxxxx if xxx xxxxxxxx xx x xxxxxx, spouse or xxxxx xx the xxxxxxxx xxx the xxxxxxxx shared x xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx was xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx xxxxxxxxx of xxxxxxxxx support xx xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx the xxxx caused xx xxx xxxxx. Xx xxxx xxxx xxxx xxx xxxxxxxx with xxx date xx xxx xxxxxxxxxx xx xxx xxxxx, xxx xxxxxx shall provide xxxxxxxx of xxx xxxx on xxxxx xx/xxx xxxxxxx xx xxx consequences. Xxx Xxxxxxxx of Justice xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx xxx xxxxx xx the abovementioned xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied for xx x xxxxxx xxx has xxxxxxxx xxxxxx harm as x result xx xxx xxxxxxxxxx xx x crime xxx xx in xxx xxxx xx x xxxx xxx xxxxxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx xxx xxxxx of medical xxxxxxxxx xx proved xx xxx victim, xxxxxxx xx any xxxxxx xxxxxxxxxx paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx harm incurred. Xxx total xxxxxx xx xxxx support xxxx xxx xxxxxx XXX 150,000. If, xxxxx the xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx that xxx harm xxxxxxxx xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx up to xxx amount of XXX 150,000 xx xx/xxx applies xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx the xxxx on xxxxx xxx xxxxxx xxxxxxx xx xxx xxxx xxxxxx by xxx xxxxx); in xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx will xx taken xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx who xxx xxxx xx a xxxxxx of the xxxxxxxxxx xx x xxxxx (a parent, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx in x xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx death or xxxxxxxxx by or xxxxxxxx to be xxxxxxxxx xx the xxxxxxxx) xxxxx xx xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx financial xxxxxxx xxxxx not xxxxxx CZK 450,000; xxxxxx xxx xxxxxx xx xxxxxxx exceed xxxxx, the xxxxxx xxxxxxxx per xxxxxx xxxxx be reduced xxxxxxxxxxx.

- Act No. 209/1997 Xxxx. xxxx xxx xxxxxxx xxx xxxxxxxxx xx the xxxxxxxxx liability xx xxxxxxxxx xx xxxxx xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx xx xxx insurers providing xxxx liability xxxxxxxxx. Xxxx xx isolated xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx support xx xxxxx with xxx Ministry xx Xxxxxxx.

- Xxxxxx xxxx xx xxxx that xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx required xxx xxx respective xxxxx xxxx xx xxxxxxxx to xxx xxxxxxxxxxx. If xxx xxxxxxxxx fails xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx deliver xxx xxxx documents xxx xxxxxxxxxxxxx even within x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx xxx xxxxxxx x decision xx withhold xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. This xxxxx xxx, however, xxxxxxxxx xxx filing xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx obliged xx xxxxxx any xxxxxxxxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx amount xx xxx xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx has xxx xxxxxxxx any xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx state's xxxxx xx claim xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx the xxxxx of xxx xxxx-xxxx xxxx, provided xxxx a xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx xx xxx xxxx xxxxxxxx and xxx amount of xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Xxxxxx xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx činnosti xxxľx xxxxxx č. 209/1997 Zb., xx xxxx vyplnenie xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Vám xx xxxxxxxxxx, xxxxx xx xxxxx ceníme.

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I. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x xxxxxxxľxxx - xxxxx trestného xxxx, xxxxxx xxôxxxxxx xxxx na xxxxxx, xxxxx osobe pozostalej xx osobe, ktorá x xôxxxxxx trestného xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx xxxxxxxx pobytu:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

II. Xx xxxxxxxľx zastupuje xxx xxxxx (zástupca) xx xxxxxxx zákonného xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx xxx xxxxx, xxxx sa xxxxxxx xxxxxxxxxx, ktorá xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (xxx xxxxxxxx zastúpení) xxxxx xxxxx rodného xxxxx (x xxxxxxx xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, aj xxxxx o xxxxxxx xxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx bola zomretá xxxxx x xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx pozostalú xxxxx xxxxx xxxx xxxxxxxxx xx xxxxxxxxx (xx vzťahu xxxxx - xxxxx xôxxx x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx xxxxx xxxxxxxx xxxx sobášny xxxx a xxx.)

XX. Xxxxxx, xx žiadate xxxxxxxx peňažnú pomoc xxxxxxxxxxxxxxx pošty xxxxx xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx xxxxxxx xxxxxxx xxxxx Xxxxx xxxx.

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

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

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

Xx xxxx k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx činného x xxxxxxxx xxxxxx, ktoré xxxx predstavu x xxx, x akom xxxxxx xx vec xxxxxxxx (napr. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx ste xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, ktorá xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Zb)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, či xxxx využila xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, ktorá zodpovedá xx škodu. Xxxxx xxx xxxxxxxxxxx, ak xxxxxxxľx trestného xxxx xxxxxxxxx.

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

VIII. Xxxxxx, či ste xxxxxxx xxxxxx, ktorá xxľxx xxxxxxxxx xxxxxxx x §2 odst. 2 xxxxxx x. 209/1997 Xx., xxxxxxxx xxľxx osôb xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

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

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

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

4. Xxľxxxx další xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Uveďte xxx počet, ak Xxx je známy.

Podľa xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Xx. xx xx obeť považuje xxxxx pozostalá xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx v čase xxxx xxxxx s xxx xxxx x xxxxxxxxxx alebo osoba, xxxxxx nebohý poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

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Body XX. xx XXX. Xxxxxxx, xx xx xxxxxxxľ xxxx xxxxxx trestného xxxx x xxxx xx xxôxxxxxx xxxx xx zdraví.

IX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx sa skončila xxxxxxxx xxxxxxxxxxx.

X. Xxxxxxx xxxxx xxxxxxxx xxxxxxxxxxx xx xxxxxx činí:

K xxxxxxxx xx xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx obsahovať xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx a bodové xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Pripomíname, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx xxxxxx ohodnotenie xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' peňažnú xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, či xxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xx xxxxx xxxxxxxxx čiastky 25 000.- Xx xxxxx xx xxxxxxxx xxxxx xxxxxx xxxxxxx a xxxxxxxx xx xxxxxxxx.

Xxxľx ustanovenia §7 xxxx. 1 xxxx. x) zákona x. 209/1997 Zb. xx xxxxxxx obete xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x ušlému xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx výške xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, xxxxxxxxx cudzej xxxxx xx xxxxx x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx xxxxxxx xx dopravu, x xxx. pod podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx sa xxxxx doložiť, xxxx xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx pomery xxxxxxxľx xxxx x xx xxxxxx ujmy xx xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx x potvrdenie xxxxxxxxxxxxľx o priemernom xxxxxxx xxxľx §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx neskorších predpisov. Xx xx žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, takou listinou xxxx xxxxxxxxx opis xxxxxxxxxx daňového priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx o xxxx xxxxxxx xxxxxxxxxx.

XXX. Uveďte xxxxx nemocenských xxxxx (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx ich xxxxxxxľ xxxxxx, xx xxxxxxx xx xxxxxx xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. X xxxxxxx, xx x xôxxxxxx xxxxx xx zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx invalidný xôxxxxxx, xxxxxx x xxxxxxx xxxx xxxxx.

Xxxx xxxxxxxxx xxxxxx xx také, že xxxxxxxx činom, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, xxxxxľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx na peňažnú xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx vedomie, že xx podľa xxx. §12 zákona x. 209/1997 Xx., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx povinnosť do xxxxxxx xxxxx xxx xxx, xxx xx xxxxxxxx pomoc, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx čiastky, ktoré xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx xx xx xxxxx xxxxxxxxxxx pomoci. Xxxxxxx x xxx xxxxxx na vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx xxxxxxxx Ministerstvo xxxxxxxxxxxxxx, aby xx x xxxx štátu xxxxxx práva xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, xxxxx xx xxôxxxxxx a xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného údaja xx jeho zatajením xx xxxxxx získania xxxxxxxxxxxx xxxxxx, sa xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) 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 o xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x udelí poradové xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx orgáne xxxľx xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x predložení xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx xxxxxxxx.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx v xxxxxxx, xx xx v xôxxxxxx trestného xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Nevyhnutnou, xxx xxxx xxxxxxxxxxxx podmienkou xx priznanie peňažnej xxxxxx xxxxx xxxxx xx výška bodového xxxxxxxxxxx xxxxxxx (xxx xxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 bodov. Xx xxxx sa považuje xx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx trestného xxxx xxxxxxx, ak xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x zároveň v xxxx xxxx xxxxx x xxx žila x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo bol xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 roka xxx xxx, keď xx xxxx dozvedela x škode xxôxxxxxxx xxxxxxxx činom. Ak xxxxx xxxx už xxx xx deň xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx okamžik, xxxx xx xx xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx vyhovieť xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx po xxxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, xxxxxxxx v xxxxxxxxx sume 25 000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx x súčet xxxxxxxx xxxxxxx, xxxxx xxxx z xxxxxx xxxxxxx xxxxx už xxxxxxx; pomoc xx xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - po tom, xxx jej xxxxxxxx xxxxx - xxxxxxxx, xx jej vzniknutá xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, na xxx xxxxxxx v xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx možno xxxxxxxxx xxxxx opäť, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx xx xxxxxxx, xxxxx už xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx bola rodičom, xxxxxxxx xxxxx dieťaťom xxxxxxxxx x xxxxxxx x xxxx jeho xxxxx s xxx xxxx x xxxxxxxxxx, xxxxx xxx xxxxxxx xxxxxxxxxx, xx bol xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx peňažná xxxxx v xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx vo xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Kč, x xx xx xxxxx obetí viac xxx xxx xxxxx, xxxxxxxxxxx čiastka xx xxx každej xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x prihliadnutím xx xxxxxxxxx xxxxxxxxx xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x poskytnutie peňažnej xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné xxxxxxx x xxxxxxxxxx, na xxxxx odkazujeme xxx xxxxxxxxxxxx položkách. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx xxx dodatočne xxxxxx, táto xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx však xxxxxxxxxx xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx žiadateľovi xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx xxxxx xxx xxx poskytnutia xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti sumy, xxxxx dostal ako xxxxxxx škody (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx nemá, xx mu xxxxx xxxxxxxxxx. Xx základe xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx môže x mene xxxxx xx uplynutí xxxxxxxxxx xäxxxxxxx xxxx xxxxx xxxxx na vrátenie xxxxxxxxxxx peňažnej xxxxxx. Xx xxxxxx postup xxôxxxxxxx sociálna xxxxxxxx xxxxx, celková xxxxx xxxxx, ktorú jej xxôxxxxxx, x xxxxx xxxxxxx, ktorú xxxx xxxxxxx.