Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx xx Xxxxxxxxx Support to Xxxxxxx xx Criminal Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx to xxx xxxxxxx xx criminal xxxx xxx on xxxxxxxx certain xxxxx xxxx, as amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx you xxxx xxxxxxxx xxxxxxxxx in xxxx current situation. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx for xxx xxxxx assessment of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Act xx. 209/1997. Xxxxx you xxx xxxx xxxxxxxxxxx; xx xx xxxxxx xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in xxx xxxxxxxx data xx xxx xxxxxxxxx - x.x. xxx xxxxxx xx the criminal xxx xxx xxx xxxxxxxx bodily xxxx, xx the xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxx of xxxxx:

4. Xxxxxxxxx address:

5. Mail xxxxxxxx xxxxxxx (xxxxxx xx xxxxxx from xxx xxxxxxxxx address, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx address:

8. Nationality:

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

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx xxxxxxxxxx address:

If xxx xxxxxxxxxxxxxx is xxxxxx the application xx xxxxxx xx xxx xxxxxxxxx, xxxxxx xxxx submit x xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of x xxxxx of attorney (xxx xxxxxxxxxxx xxxxxxxxxxxxxx) xx a xxxx xx the xxxxx xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) or xxx xxxxx equivalent xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx a person xxx xxx died xx xxxxxxxxxxx xx xxx respective criminal xxx, xxxxxx fill xx the xxxxxxxx xxxx of xxx xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Date xx xxxxx:

5. Xxxx xxxxxxxxx xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx the xxxxxxxx xx the applicant (x.x. xxxxxx, daughter, xx xxxxxxxxxx living xx common xxxxxxxxx)

Xx xxx applicant xx x xxxxxxxx of x xxxxxx xxx xxxx in xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x xxxx xx xxx xxxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx an xxxxxxxxxx xx support xxx xxxxxxxx (xx xxx xxxx xx a xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx couples, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxxx).

Xxxxxx specify xxx xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, if xxx victim xxxxxxx xxxxx the consequences xx xxx crime xx x xxxxx xxxx, xxxxxx also xxxxxxx xxx date xxx xxx xxxxxx xx xxxxx xxx xxxxxx learned of xxxx xxxxxxxxxxxx (x.x., xxx xxxx xx xxx medical xxxxxx).

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

Xx xxxxxxxxx, please xxxxxx xxx latest xxxxxxxx xx xxx abovementioned xxxxxxxx xxxxxxx authority xxxxx could indicate xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx discontinuation of xxxxxxxx prosecution, xxxx xx the indictment, xxxxxxxxx - final xx xxxxxxxxx).

According xx xxx xxxxxxxxxx xx §8 of Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx support xxx xx reduced xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx xxxx use xx xxx xxxxx xxxxxxxx xx enforce x claim xxx xxxxxxxxxxxx against xxx xxxxxxxx xx any xxxxx xxxxxx xxxxxxxxxxx xxx the xxxx xxxxxxxx. Xx not xxxx in xxxx xxxx if the xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx VlIl xx xxx xxxxxxxxx is x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxxx crime.

1. Xxx xxx x xxxxx, xxxxxx or xxxxx of xxx xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxxxxxx?

2. Xxx you xxxx xx x common xxxxxxxxx xxxx xxx xxxxxxxx xxxxxx xxxxx xx the xxxxxxxxxx xx the crime?

3. Xxxx xxx a xxxxxxxxx of xxx xxxxxx xx xxx xxx deceased xxxxxxx xx xxxxxxx xxx?

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

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Xxxxxxxxx xx xxx provisions xx §2, section 2 of Xxx xx. 209/1997, x xxxxxx xxx xx x xxxxxxxx of x xxxxxx xxx xxxx xx consequence xx a xxxxxxxx xxx xx considered xx xx x xxxxxx xx xx xx she xx x parent, xxxxxx xx xxxxx of xxx xxxxxxxx and xxxxx xxxx xxx xx her xx xxx same xxxxxxxxx xx xx the xxxxxx xxx x xxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx the xxxxxx.

Xx xxx applicant xx the xxxxxx xx x crime xxx xxx xxxxxxxx xxxxxx xxxx, please xxxx xx xxxxx XX - XXX.

Please attach x xxxxx-xxxxx assessment xx pain and xxxxxxxxx pursuant xx Xxxxxx No. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx should be xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx a xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx xxx x xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx of xxx xxxxxx'x xxxxxx xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx xxxx xxx xxxxx-xxxxx assessment xx xxx pam xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. Xxxxxxxxx to xxx xxxxxxxxxx xx §6, section 2 xx Xxx no. 209/1997, xx financial xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx xx xxx pain suffered xx xx xxxxx 100 points.

Xxx xxxxxx xxx xxxxxx xxxx sum xxxxxxxxx xxxxxxx in xxx xxxxxx xx CZK 25,000 or xx xxxxxx equal to xxx xxxxxx costs xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, section 1, xxxxxx x of Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx xx apply xxx x xxxx xxx payment, xxxxx xx xx need xx xxxx in xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, sanitary xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx to xxxx xxx xx xxx xxxx xx xxxx medical treatment, xxxxxxxxx transportation xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx not xxxx xxxx by xx xxxxxxxxx company. xx xxxx xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx xxxx into xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx xx xx xxxxxxxx, xxxxx documents xxxxx include a xxxxxxxxx xxxx his/her xxxxxxxx describing xxx xxxxxxx xxxxxx according xx §351 xx. xxx. xx Xxx xx. 262/2006, the Xxxxx Xxxxxx Code, xx amended. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx is a xxxxxxx xxxxxx xxx xx xxxx to xxxxx xxx/xxx impaired xxxxxx xxxxxxxx, xxxxxx xxxxxx x xxxxxxxx xxxxxxxxxx the amount xx the xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x income xxxxxxxxx xxxxxx be xxxxxx, xx exceptional xxxxx xx xxxxxxxxx xxx xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx as x xxxxxx of xxx criminal xxx xx xxxxx I xxx x victim. X have xxx xxx xxxx compensated xxx the xxxx 1 xxxx xxxxxxxx xx a xxxxxx xx the xxxxxxxx xxx.

X hereby affirm xxxx X xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx xx any country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx according to §12 of Act Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx xxxx xxx on xxxxxxxx xxxxxxx xxxxx xxxx, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx the Xxxxxxxx xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, xx xx xxx xxxxxx xx xxx xxxxxxxxx xxxxxxx, xxxxxx xxxx xxxxx xxxx the xxxx of xxxxxxxxx xxx funding support. X also xxxxxxxxxxx xxxx, after xxx xxxxx of the xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx xx Xxxxxxx xx waive the xxxxx'x xxxxx xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx xxxx a xxxxxx be xxxx xxxxxxxx by my xxxxxx standing, the xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx false xx xxxxxxxxxx xxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx xxxxxxxxx xx xxxxxxx xxxxxxxx to §21, section 1, xxxxxx x) xx Xxx no. 200/1990 Xxxx., on xxxxxxxx xx amended.

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Signature xx xxx applicant or xxx/xxx xxxxxxxxxxxxxx

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx the xxxxxxxxx of xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx shall xxxxxxx xxxxxxx and xxxxxx xx x serial xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx xxxxx initiate xx investigation xxxx xxx xxxxxx xx x similar xxxxxxxxx xx per the xxxxxxxx xxxxxxx xx xxx case. Xxxxxx xxxxx xxxxxx from xxx xxxx xx xxx xxxxxxx of xxx xxxxxxxxxxx xxx xxxxxxxxxx xx the xxxxxxxxx documents, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx xxxx xxxxxxx xxx been xxxxxxxx.

- Xxx applicant xxxxx xx xxxxxxxxxx x victim xx xxx Xxx No. 209/1997 Coll. only xx he/she xxx xxxxxxxx bodily xxxx xx a xxxxxx xx xxx xxxxxxxxxx xx x crime. X necessary but xxx xxx ohly xxxxxxxxx xxx the xxxxxx'x receipt xx xxxxxxxx xxxxxxx shall xx xxx amount xx the xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx (not xxx weakening xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx who xxx xxxx in consequence xx x xxxxx xxxxx xx considered xx xx x xxxxxx xx the xxxxxxxx xx a xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx and xxx xxxxxxxx xxxxxx a xxxxxxxxx xxxx the xxxxxxxx xx xxx xxxx of xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx was xxxxxxxx xx support the xxxxxxxx.

- Act No. 209/1997 Coll. on xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx xxxxxxx xx the xxxx caused by xxx xxxxx. If xxxx xxxx xxxx xxx coincide xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx shall provide xxxxxxxx xx xxx xxxx xx which xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx received xxxxxxx xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx support xx applied xxx xx a xxxxxx xxx has suffered xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx of x xxxxx may xx xx the xxxx xx x xxxx xxx xxxxxxxxx xx XXX 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx the xxxxx xx xxxxxxx xxxxxxxxx as xxxxxx xx the victim, xxxxxxx xx xxx xxxxxx previously xxxx xx xxx victim xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx xxxxxx xx xxxx support xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx xxx provision xx support, the xxxxxx xxxxxx xxxx xxx xxxx suffered xxxxxxx the xxxxxx xxxxxxxx, xxx xxxxxx xxx receive additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 xx xx/xxx xxxxxxx xxx xx within xxx xxxxxxxxxxxxxx period xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx learned xx xxx harm xxxxxx xx the xxxxx); in xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx xxxx xx xxxxx xxxx xxxxxxx.

- Xx individual xxx is a xxxxxxxx xx x xxxxxx xxx has xxxx as x xxxxxx of the xxxxxxxxxx xx x xxxxx (a parent, xxxxxx or xxxxx xx xxx xxxxxxxx xxxxxx in x xxxxxx xxxxxxxxx with xxx deceased xx xxx time xx xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx be xxxxxxxxx xx the xxxxxxxx) shall be xxxxxxxx xxxx a xxxx sum amounting xx CZK 150,000. Xxx total amount xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx CZK 450,000; xxxxxx the xxxxxx xx xxxxxxx xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx victim xxxxx xx reduced xxxxxxxxxxx.

- Act No. 209/1997 Xxxx. does xxx xxxxxxx xxx xxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx motor xxxxxxxx xxxxxxx xx xxxxxxxxxx liability xxxxxxxxx. Xx matters xxxxxxx xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should xxxx xx xxxxxxxx xx xxx xxxxxxxx xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, in view xx xxxxxxxxxxx circumstances, xxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial support xx xxxxx with xxx Xxxxxxxx xx Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx respective xxxxx xxxx xx xxxxxxxx to xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx process xxx xxxxxxxxxxx. Xxxxxx xxx xxxxxxxxx xxxx xx xxxxxxx any xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx within x supplementary xxxxxxxx, xxxx xxxx may xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx xx xxx Xxx Xx. 209/1997 Xxxx. This xxxxx xxx, however, xxxxxxxxx xxx xxxxxx of xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xx xxxxxx xxx xxxxxxxxx amount received xx xxxxxxxxxxxx xxx xxxx (from xxx xxxxxxxx, xxxxxxxx xxx.) xx xxx xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx amount xx the xxxxxxx xxxxxxxx. Xxxx obligation xxxx xxx xxxxx xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. If so xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxxxx xxx state's xxxxx xx xxxxx xxx xxxxxx xx xxx financial support xxxxxxxx after xxx xxxxx of xxx xxxx-xxxx xxxx, provided xxxx a waiver xx xxxxxxxxx xx xxx xxxxxx'x xxxxxx xxxxxxxx, xxx total xxxxxx xx xxx xxxx suffered and xxx xxxxxx of xxxxxxxxxxxx paid xx xxx xxxxxx.

Vážený pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x ktorej xx xxxxxxxxxx, sme xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx xxxxxxxx. X xxxxxx xxxxxxxx posúdenia Xxxxx žiadosti x xxxxxxxxxxx peňažnej xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx zákona č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx dotazníku xxxxxxxxxx. Xxxxxxxx Xxx za xxxxxxxxxx, xxxxx si xxxxx ceníme.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum narodenia:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje iná xxxxx (zástupca) xx xxxxxxx xxxxxxxxx zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx základe xxxxxx x xxxxx xxxx, xxxxxxx xxxxx o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx rodného listu (x prípade xxxxxxxxx xxxxxxxxxx) alebo xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx po osobe, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, xxxxxxx, xxxxxx, aj xxxxx x xxxxxxx xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné bydlisko:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx v xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (otec, xxxxx, osoba xxxxxx x spoločnej domácnosti):

Ak xx xxxxxxxľ osobou xxxxxxxxxx xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx listu x xxxxxxx, ktoré dokladajú xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx vyživovať (xx vzťahu rodič - dieťa xôxxx x xxxxx list xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx povinnosti, xxx manželov takou xxxxxxxx bude xxxxxxx xxxx a pod.)

IV. Xxxxxx, či žiadate xxxxxxxx peňažnú xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx peňažný xxxx; v xxxxx xxxxxxx xxxxxxx oznámte xxxxx Xxxxx účtu.

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

Xxxxxx xxxxx xxxxxxxxx trestného xxxx x ak xx xxxx o xxxxx xxx xxôxxxxxxx dozvedela xx xxxxôx, xxxxxx xxxx x ako (xxxxxxxxx x xxxxxxxxx xxxxxx - xxxxx xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx v xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie o xxxxxxxx čine. Uveďte xx xxxxxxx xxxxxx, xxx ktorou prebieha xxxxxxxxxxxx.

Xx máte x xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx činného x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, v xxxx xxxxxx sa xxx xxxxxxxx (xxxx. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), xxxxxxxx ho x xxxxxxxx.

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

Podľa ustanovenia §8 xxxxxx x. 209/1997 (Xx)., xxxxxxxx xxxxx sa xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, či xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku na xxxxxxx škody od xxxxxxxľx alebo inej xxxxx, ktorá xxxxxxxxx xx škodu. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx XXXX. Vyplňte, xx žiadateľ xx xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx ste xxxxxxx osobou, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx osôb xxľxx xxxxx podmienky, ak xx Vám xxxxx xxxxxxxxxxx xxxxx.

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

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

3. Poskytovala Xxx xxxx trestného xxxx xxxxxx, či xxxx x xxxx povinná?

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

Podľa xxxxxxxxxxx §2 odst. 2 xxxxxx č. 209/1997 Zb. sa xx obeť xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, ktorá v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak xx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx xxxx xxxxx s xxx xxxx x xxxxxxxxxx xxxxx xxxxx, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx xx žiadateľ xxxx obeťou xxxxxxxxx xxxx x bola xx xxôxxxxxx ujma xx zdraví.

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

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové ohodnotenie xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., xxxxx xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx sťaženia spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx ohodnotenie xxxxxxxxx bolesti. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx x. 209/1997 Xx. nemožno xxxxxxxxx' xxxxxxx pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Xxxľx xxxxxxxxxxx §7 odst. 1 xxxx. x) xxxxxx x. 209/1997 Zb. xx xxxxxxx obete xxxxx xxxxxxxxx xxxxxxx xxxxx xx xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx na liečenie x ušlému xxxxxxx. Xx xx xxxxxxxxxx xxxxxx x peňažnú xxxxx xx výške xxxxxxxxx čiastky, xxxxxxxx xx vyplňovať xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx lieky, zdravotnícke xxxôxxx, náklady na xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx na pomoc x xxxxxxxxxx či xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx xx xxxxx xxxxxxx, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx pomery xxxxxxxľx xxxx a xx xxxxxx ujmy na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx skutočnosti.

V prípade, xx xxxxxxxľ xx x zamestnaneckom xxxxxx, xôxxx x potvrdenie xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx práce, x xxxxx xxxxxxxxxx predpisov. Xx xx žiadateľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx listinou xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového xxxxxxxxx. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx xxxxxxxx situáciu, xxxx potvrdenie x xxxxx xxxxxxxxxx dôchodku. X xxxxxxx, xx x nejakého závažného xôxxxx xxxxxxx xxxxxxx xxxxxxxxx pomery žiadateľa, x xxxxxxx xxxxxxx xx možné xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx vyhlásením.

XIV. Uveďte xxxxx nemocenských dávok (xxxxxxxxxxx dôchodku) a xxxx, xxxxxx xxx xxxxxxxľ poberá, xx xxxxxxx po vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x výške xxxxxxxxxxxx xxxxx. V prípade, xx x dôsledku xxxxx xx xxxxxx xxôxxxxxxx xxxxxxxx činom Xxx priznali invalidný xôxxxxxx, xxxxxx x xxxxxxx xxxx výšku.

Xxxx xxxxxxxxx pomery xx xxxx, xx xxxxxxxx činom, ktorého xxx bol(a) xxxxxx, xx moja sociálna xxxxxxxx xxxxxxxx. Škodu, xxxxx mi takto xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx na xxxxxxx xxxxx xx xxxxxxx xxxxx na odškodnenie xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Xxxxxxxxxx) republike.

Beriem xx vedomie, xx xx podľa xxx. §12 xxxxxx x. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x o xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx xxx xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx účet Ministerstva xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx dostal(a) xxx xxxxxxx škody, x xx xx do xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby sa x xxxx štátu xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx bude xxxx xxxxxx odôvodňovať, celková xxxxx xxxxx, ktorú xx xxôxxxxxx x xxxxx náhrady, ktorú xxx dostal(a).

Beriem tiež xx vedomie, že xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx xxxxxxxxx údaja xx jeho xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, sa xôxxx xxxxxxxx priestupku xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx žiadosti x xxxxxxxxxxx peňažnej pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Xxxxx bude xxxxxxxxxx xx polícii xx xx xxxx xxxxxxxx xxxxxx xxxľx xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x predložení potrebných xxxxxxxx buď xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, prečo xxxxx nemožno xxxxxxxx.

- X xxxxxx zákona č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx za xxxx xxx v xxxxxxx, xx mu x xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx takej xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx aspoň 100 xxxxx. Xx xxxx xx xxxxxxxx xx xxxxx xxxxxxxxx xx obeti, xxxxx x dôsledku trestného xxxx xxxxxxx, ak xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x xxxx xxxx xxxxx x xxx žila x xxxxxxxxxx, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo bol xxxxxxx poskytovať výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx činu, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx vyhovieť xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx mu xxxxxxxx po xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx na xxxxxxx xxxxx, xxxxxx x xôxxxxxx trestného xxxx xxxxxxx xxxxx xx xxxxxx, poskytne x xxxxxxxxx sume 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 už xxxxxxx; pomoc xx xxxxxx súčte nesmie xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - po xxx, xxx xxx xxxxxxxx xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx xx xxxxxx xxx xx, ktorá xxxx xxxxxxxxx na xxxxxxxxxxx xxxxxx, xx xxx žiadosť x xxxxxx xxxxxxxxxx xxxxx xxxxxxx jej xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Kč; xxxxxx xx xxxxxxxxxx na xxxxxxx, ktoré už xxxx vyplatené.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx obeti, xxxxx v dôsledku xxxxxxxxx činu xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxx xxxxxxx xxxxxxxxxx, xx bol xxxxxxx poskytovať výživu), xx xxxxxxxx xxxxxxx xxxxx v paušálnej xxxx 150 000.- Xx; xxxxx xx svojom xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Xx, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx každej xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx povinné xxxxxxx poistenie xxxxxxxxxxxxx. Xxxxx xx potrebné x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx spravuje poistenie xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx s xxxxxxxxxxxxx xx xxxxxxxxx xxxxxxxxx xxxxxxxxx je možné xxxxxx xxxxxxxxxxxx xxxxxxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx xxxxxxx x potvrdenia, na xxxxx xxxxxxxxxx pri xxxxxxxxxxxx xxxxxxxxx. Ak xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxx žiadosť. Ak xxxxxx xxxxxxxxxx x xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx dôvodom xxxxxxxxxxxxx peňažnej pomoci xxxľx xxxxxx č. 209/1997 Zb. Xx však nevylučuje xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je do xxxxxxx rokov xxx xxx xxxxxxxxxxx pomoci xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx ako xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxx povinnosť xxxx, xx mu xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx spravodlivosti môže x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx peňažnej xxxxxx. Xx takýto postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx výška xxxxx, xxxxx xxx xxôxxxxxx, a xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.