Plné znění - 241/2006 Sb.

Questionnaire xxx the Xxxxxxxxxx xx Xxxxxxxxxxxx for xxx Xxxxxxxxx of Xxxxxxxxx Support xx Xxxxxxx xx Criminal Xxxx pursuant to Xxx No. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx to the xxxxxxx xx xxxxxxxx xxxx and on xxxxxxxx xxxxxxx other xxxx, as amended

Dear Xxx/Xxxxx,

Xx apologise xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx current situation. Xxxxxxx, xxxxxxx xx xxxx xxxxxxxxxxxxx is xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support pursuant xx Xxx xx. 209/1997. Xxxxx xxx xxx xxxx xxxxxxxxxxx; xx is highly xxxxxxxxxxx.

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X. Please xxxxxxx xxxx in xxx xxxxxxxx xxxx xx xxx applicant - x.x. xxx victim xx xxx criminal xxx xxx xxx xxxxxxxx bodily xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

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

6. Xxxxx Number:

7. X-xxxx address:

8. Xxxxxxxxxxx:

XX. Xx xxx xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("representative") xx xxx basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx xxx/xxx xxxxxx) xx xx the xxxxx xx x xxxxx of xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxxxxxxx xx registered address:

If xxx xxxxxxxxxxxxxx is xxxxxx xxx application xx xxxxxx xx xxx applicant, xxxxxx xxxx xxxxxx x xxxxxxxx xxxxxxxxxxx him/her xx xxxxxxxxx xxx xxxxxxxxx - x xxxx of x xxxxx of xxxxxxxx (xxx xxxxxxxxxxx representation) xx x copy xx xxx birth xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) or xxx xxxxx xxxxxxxxxx document.

III. Xx the xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxx died xx consequenee xx xxx xxxxxxxxxx xxxxxxxx xxx, xxxxxx xxxx xx the xxxxxxxx xxxx of the xxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Xxxxxxxxxxxx xx xxx xxxxxxxx xx the xxxxxxxxx (x.x. father, xxxxxxxx, xx individual xxxxxx xx xxxxxx household)

If xxx xxxxxxxxx xx x xxxxxxxx xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx criminal xxx, xxxxxx xxxxxx x copy xx xxx xxxxx certificate xxx any xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx xxxxxxxxx xx xxx an obligation xx xxxxxxx xxx xxxxxxxx (xx the xxxx of x xxxxxx-xxxxx relationship, such xxxxxxxxx xxxxxxx birth xxxxxxxxxxxx or x xxxxx decision on xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx certificate).

Xxxxxx xxxxxxx xxx xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx and, xx xxx xxxxxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx crime xx x later xxxx, xxxxxx also xxxxxxx xxx xxxx xxx xxx xxxxxx xx xxxxx xxx xxxxxx xxxxxxx of xxxx xxxxxxxxxxxx (x.x., xxx date of xxx medical xxxxxx).

XX. Xxxxxx xxxxxxx the xxxxxxxx justice xxxxxxxxx (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx most xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx xxxxxxx xx xxx respective proceedings.

If xxxxxxxxx, xxxxxx attach xxx xxxxxx decision xx xxx abovementioned xxxxxxxx justice authority xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. resolution xx xxx discontinuation xx xxxxxxxx prosecution, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx xxx provisions xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx xxxxxxx xx xxxxxxxx depending xx xxxxxxx xxx xxxxxx xxx xxxx xxx xx all legal xxxxxxxx xx xxxxxxx x claim for xxxxxxxxxxxx against the xxxxxxxx xx any xxxxx xxxxxx responsible xxx the xxxx xxxxxxxx. Do not xxxx xx xxxx xxxx if xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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Xxxx in xxxx VlIl if xxx applicant xx x xxxxxxxx of xx individual xxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxxx xxxxx.

1. Xxx xxx x xxxxx, spouse or xxxxx xx xxx xxxxxx who xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx offence?

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

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

4. Xx xxx other xxxxxxx xxxx the xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Please give xxxxx xxxxxx, if xxxxx xx you.

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According xx the xxxxxxxxxx xx §2, xxxxxxx 2 xx Act xx. 209/1997, a xxxxxx xxx xx x xxxxxxxx of x victim who xxxx in consequence xx x xxxxxxxx xxx is xxxxxxxxxx xx xx x xxxxxx if xx xx xxx is x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxxxx xxxx xxx xx her xx xxx xxxx xxxxxxxxx xx if xxx xxxxxx xxx a xxxxxxxxx xx the xxxxxxxx or the xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

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

Xxxxxx xxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx No. 440/2001 Xxxx. The respective xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx xxxxxxxxxxx for xxx victim's treatment. Xxxx xxxxxxx xxxxxx xxxx contain a xxxxx-xxxxx xxxxxxxxxx xx xxx pam xxxxxxxx xxx x point-based xxxxxxxxxx xx the xxxxxxxx xx xxx xxxxxx'x xxxxxx position. Xxxxxx xxxx in xxxx xxxx xxxx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx is xxxxxxxx xxx the xxxxxxxx xx Act no. 209/1997. Xxxxxxxxx xx xxx provisions xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx xxxxxx xxx xxxxx assessment xx xxx pain suffered xx xx least 100 points.

Xxx xxxxxx may obtain xxxx sum financial xxxxxxx in xxx xxxxxx of XXX 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). xx xxx xxxxxx to xxxxx xxx x lump xxx xxxxxxx, xxxxx xx xx need xx fill xx xxxxx XII - XxX.

Xxxx xxxxxxxx xxx expenses xxx xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx costs, xxxxxx xx assistant xx xxxx xxx xx xxx home xx xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx costs xxx., xxxxxxxx xxxx xxxxx have not xxxx xxxx xx xx insurance xxxxxxx. xx xxxx xxxxxxxx xxx xxx proved xx xxxxxxxxxxx xxxxxxxx, xxx Ministry xx Xxxxxxx xxx not xxxx xxxx xxxx xxxxxxxxxxxxx.

Please attach xxx documents xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx xxx xxxxxxxxx xx xx xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx x xxxxxxxxx xxxx his/her xxxxxxxx describing xxx xxxxxxx xxxxxx xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, xxxx document xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx xxx xxxxxx. xx the xxxxxxxxx xx a xxxxxxx xxxxxx who xx able to xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx a xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx retirement xxxxxxx. lf xxx xxx xxxxxx the xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx be proven, xx exceptional cases xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx xxx xxxx impaired xx x xxxxxx xx xxx xxxxxxxx act xx xxxxx X xxx a victim. X xxxx xxx xxx been compensated xxx the harm 1 have xxxxxxxx xx x result xx the xxxxxxxx xxx.

X hereby xxxxxx xxxx X have xxx lodged xxx xxxxx xxx xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx for xxxxxxxxxxxx for the xxxx suffered xx x xxxxxx of xxx criminal xxx xx any xxxxxxx xxxxx than xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 xx Xxx Xx. 209/1997 Coll., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx xxxxxxx xx xxxxxxxx acts xxx on amending xxxxxxx xxxxx xxxx, xx amended, I xx xxxxxxx to xxxxxxxxx the Xxxxxxxx xx Justice any xxxxxx received xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx, up xx xxx xxxxxx xx the financial xxxxxxx, xxxxxx xxxx xxxxx from the xxxx xx xxxxxxxxx xxx xxxxxxx support. X also acknowledge xxxx, xxxxx the xxxxx xx xxx xxxx-xxxx xxxxxx, I xxx xxxx xx xxxxxxxxxxx xxxxxx xxx Xxxxxxxx of Xxxxxxx xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx standing, the xxxxx xxxxxx xx xxxx xxxxxxxx xxx xxx amount xx xxxxxxxxxxxx received.

I xxxx xxxxxxxxxxx that consciously xxxxxx false xx xxxxxxxxxx information xx xxxxxxxxxxx information xxx xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent xx xxxxxxx xxxxxxxx to §21, xxxxxxx 1, xxxxxx x) xx Xxx no. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx xx xxx/xxx representative

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Xxx Xx. 209/1997, xxx Ministry of Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx x serial xxxxxx. Subsequently, the Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx xxxx xxx xxxxxx or x similar authority xx xxx xxx xxxxxxxx details of xxx xxxx. Xxxxxx xxxxx xxxxxx from xxx xxxx of xxx receipt xx xxx xxxxxxxxxxx and xxxxxxxxxx of xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx of the xxxxxxx xxx such xxxxxxx xxx xxxx xxxxxxxx.

- The applicant xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Xxx Xx. 209/1997 Coll. xxxx xx xx/xxx xxx xxxxxxxx xxxxxx xxxx xx x result xx xxx xxxxxxxxxx xx x xxxxx. X necessary xxx xxx xxx xxxx xxxxxxxxx for the xxxxxx'x receipt of xxxxxxxx support xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx of xxx xxx xxxxxxxx (not xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx xx xx xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx who xxx xxxx in xxxxxxxxxxx xx x xxxxx xxxxx be considered xx xx a xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx xx xxx xxxxxxxx and xxx xxxxxxxx shared a xxxxxxxxx xxxx xxx xxxxxxxx at the xxxx of xxx/xxx xxxxx xx xx xxx deceased xxxxxxxxx xx xxx xxxxxxxx xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Coll. xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx stipulates x xxxxxxxxxx term xx 1 xxxx xxxx xxx xxxx on xxxxx xxx victim xxxxxxx xx xxx xxxx caused by xxx xxxxx. Xx xxxx xxxx xxxx xxx coincide with xxx xxxx of xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx xxxxx provide xxxxxxxx of xxx xxxx xx xxxxx xx/xxx learned xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx xx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx received anytime xxxxx the xxxxx xx xxx abovementioned xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied xxx xx x victim xxx xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx of x xxxxx may xx xx the xxxx xx x xxxx xxx amounting xx CZK 25,000 xx xx xxxxxx xxxxx xx xxxx xxxxxx xx the xxxxx xx xxxxxxx xxxxxxxxx as proved xx xxx xxxxxx, xxxxxxx xx xxx xxxxxx previously paid xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xxx xxxxx amount xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. Xx, xxxxx xxx xxxxxxxxx xx support, the xxxxxx proves xxxx xxx harm suffered xxxxxxx xxx xxxxxx xxxxxxxx, xxx xxxxxx xxx receive additional xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx xxxxxx xx xxxx (x.x., 1 xxxx xxxx xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx xxxxxxx xxxxxxx xxxx will xx xxxxx xxxx xxxxxxx.

- Xx individual xxx is x xxxxxxxx xx x xxxxxx who has xxxx as x xxxxxx of xxx xxxxxxxxxx xx x xxxxx (a xxxxxx, xxxxxx xx xxxxx xx xxx deceased xxxxxx xx x xxxxxx xxxxxxxxx xxxx xxx deceased xx xxx xxxx xx xxx/xxx xxxxx or xxxxxxxxx xx or xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) shall xx xxxxxxxx xxxx x xxxx xxx amounting xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx not xxxxxx XXX 450,000; xxxxxx the number xx xxxxxxx exceed xxxxx, xxx amount xxxxxxxx per xxxxxx xxxxx xx reduced xxxxxxxxxxx.

- Xxx Xx. 209/1997 Coll. xxxx xxx replace xxx xxxxxxxxx xx the xxxxxxxxx xxxxxxxxx xx xxxxxxxxx xx xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx liability xxxxxxxxx. Xx matters related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx for xxxxxxxxx xxxxxxxx xxxxxx xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx liability insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx xxx provision xx xxxxxxxxx support xx xxxxx xxxx xxx Xxxxxxxx xx Xxxxxxx.

- Please xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxxxxxx xxx xxx respective xxxxx must xx xxxxxxxx xx xxx xxxxxxxxxxx. If xxx xxxxxxxxx fails xx xx so, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx xxxxxxxxx xxxx xx xxxxxxx any xxxx documents and xxxxxxxxxxxxx xxxx xxxxxx x xxxxxxxxxxxxx deadline, xxxx xxxx may xxxxxxx x xxxxxxxx xx xxxxxxxx xxx xxxxxxx as xxx Xxx No. 209/1997 Xxxx. Xxxx xxxxx xxx, xxxxxxx, xxxxxxxxx xxx xxxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxxxxx xxxx xx mind xxxx the xxxxxxxxx xxxxx be obliged xx return any xxxxxxxxx xxxxxx xxxxxxxx xx compensation xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx the xxxxxxx xx the Xxxxxxxx xx Justice up xx xxx amount xx xxx xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx so xxxxxxxxx xx xxx xxxxxx xx xx xxxxxxxxxxx, the Xxxxxxxx xx Xxxxxxx may xxxxx xxx xxxxx'x xxxxx to claim xxx return xx xxx financial xxxxxxx xxxxxxxx xxxxx xxx xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx a xxxxxx xx xxxxxxxxx xx xxx victim's xxxxxx xxxxxxxx, the total xxxxxx xx xxx xxxx suffered xxx xxx amount xx xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, že v xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx obťažovať xxxxxxxxxxxx otázkami. V xxxxxx xxxxxxxx posúdenia Xxxxx žiadosti o xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej xxxxxxxx xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx za xxxxxxxxxx, xxxxx xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx osobné xxxxx x xxxxxxxľxxx - obeti trestného xxxx, xxxxxx xxôxxxxxx xxxx xx zdraví, xxxxx xxxxx pozostalej xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

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

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. maloleté dieťa xxxxxx rodičom) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx údaje o xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx žiadate xx xxx xxxxx, xxxx sa doložiť xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Preto x xxxxxxxx xxxxxxxx xxxxx xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx xxxxx (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

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

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx bydlisko:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx xxxxxxx xxxxx x xôxxxxxx xxxxxxxxx xxxx k xxxxx žiadateľa (xxxx, xxxxx, xxxxx xxxxxx x xxxxxxxxx domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x žiadosti sa xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx x xxxxxxx, ktoré dokladajú xxxxxxxxxx, xx xxxxxx xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx vyživovať (xx vzťahu xxxxx - dieťa xôxxx x xxxxx xxxx xxxxx rozhodnutie xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx manželov xxxxx xxxxxxxx xxxx xxxxxxx xxxx x xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx xxxx.

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

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x ak sa xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x ako (xxxxxxxxx z xxxxxxxxx xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx xxxxx x xxxxxxxx xxxxxx (policajný xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx xxxxxxx o xxxxxxxx xxxx. Xxxxxx xx xxxxxxx značku, xxx ktorou prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx rozhodnutie xxxxxx xxxxxxx x xxxxxxxx konaní, ktoré xxxx predstavu o xxx, x xxxx xxxxxx xx xxx xxxxxxxx (napr. uznesenie x odložení xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), pripojte xx x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx inej xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 xxxxxx č. 209/1997 (Xx)., xxxxxxxx xxxxx sa môže xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx xx, xx xxxx využila xxxxxx xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx nároku xx xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, ktorá xxxxxxxxx xx škodu. Xxxxx xxx xxxxxxxxxxx, xx xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

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

XXXX. Xxxxxx, či ste xxxxxxx xxxxxx, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 zákona č. 209/1997 Xx., xxxxxxxx xxľxx osôb xxľxx xxxxx podmienky, ak xx Vám xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx trestného činu?

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

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

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

Podľa xxxxxxxxxxx §2 xxxx. 2 zákona č. 209/1997 Xx. xx xx obeť považuje xxxxx xxxxxxxxx xx xxxxx, ktorá v xôxxxxxx trestného xxxx xxxxxxx, ak je xxxxxxx, xxxxxxxx xxxxx xxxxxxxx zomretého x xxxxxxx v xxxx xxxx xxxxx x xxx žila v xxxxxxxxxx xxxxx osoba, xxxxxx nebohý poskytoval xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

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Xxxx XX. xx XIV. Xxxxxxx, xx sa žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx spôsobená ujma xx xxxxxx.

XX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, xxxxxxxxxx xxxx xx xxxxxxxx xxxxxxxx neschopnosť.

X. Xxxxxxx xxxxx xxxxxxxx ohodnotenia xx xxxxxx xxxx:

X xxxxxxxx xx xxxx xxxxxxxx bodové ohodnotenie xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx xx xxxxxx, xxxxx xx xxxxxxxxx. Xxxxx xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx relevantné xxx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 xxxxxx č. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

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

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) zákona x. 209/1997 Zb. xx xxxxxxx xxxxx xxxxx poskytnúť peňažnú xxxxx xx xxxxx xxxxxxxxx xxxx 25 000.- Xx, alebo xx xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx liečenie x xxxxxx xxxxxxx. Xx sa xxxxxxxxxx xxxxxx x xxxxxxx xxxxx vo výške xxxxxxxxx xxxxxxx, xxxxxxxx xx vyplňovať body XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx s xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx pomoc x xxxxxxxxxx xx xxxxxxxxxx, zvýšené xxxxxxx xx xxxxxxx, x xxx. xxx xxxxxxxxxx, xx xxxxx náklady xxxxxxxxx xxxxxxxxx. Xx xxxxxxx xxxxxxx sa xxxxx doložiť, inak xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx nebude xxxx xxxx xxxxxľ.

XXXX. Xxxxxxx xxxxxxxxx pomery xxxxxxxľx xxxx a po xxxxxx xxxx xx xxxxxx xxôxxxxxxx trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx xxxxxxxxxx xxxxxxx xxxxxxxxxxx.

X prípade, xx žiadateľ xx x zamestnaneckom xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Zb., xxxxxxxx práce, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx samostatne xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx žiadateľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx dokázať xxxxxxxx sociálnu situáciu, xxxx potvrdenie o xxxxx starobného xôxxxxxx. X prípade, xx x xxxxxxxx xxxxxxxxx xôxxxx nemožno xxxxxxx xxxxxxxxx pomery žiadateľa, x xxxxxxx prípade xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) a xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, či xxxxxxx xx vzniku xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo poisťovne x výške xxxxxxxxxxxx xxxxx. X prípade, xx v xôxxxxxx xxxxx na xxxxxx xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx jeho výšku.

Xxxx xxxxxxxxx pomery xx xxxx, že xxxxxxxx xxxxx, xxxxxxx xxx xxx(x) obeťou, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx takto xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, xx xxxxx na peňažnú xxxxx či obdobný xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx xxx neuplatnil(a) x žiadnom xxxx xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx podľa xxx. §12 xxxxxx x. 209/1997 Zb., x xxxxxxxxxx peňažnej xxxxxx xxxxxxx trestnej xxxxxxxx x x xxxxx x x xxxxxxxx xxxxxxxxxx zákonov, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx rokov xxx xxx, keď mi xxxxxxxx xxxxx, xxxxxxx xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, ktoré xxx xxxxxx(x) xxx xxxxxxx xxxxx, a xx xx xx xxxxx poskytnutej xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx požiadať Xxxxxxxxxxxx xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx moja sociálna xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx škody, xxxxx xx xxôxxxxxx x xxxxx náhrady, ktorú xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx uvedením nesprávneho xxxxx xxxxxxxxx xxxxx xx jeho xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť priestupku xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x priestupkoch, x znení neskorších xxxxxxxxx.

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xxxxxx žiadateľa alebo xxxxxxxx

- Xxxxxxxxxxxx spravodlivosti Xxxxx xxxxxxxxx xx xxxxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx jej xxxxxx x xxxxx xxxxxxxx xxxxx. Potom bude xxxxxxxxxx xx polícii xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx prípadu. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x xxxxxxxxxx potrebných xxxxxxxx buď pomoc xxxxxxxx xxxxx žiadateľovi xxxxxx xôxxxx, xxxxx xxxxx nemožno poskynúť.

- X zmysle xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx za xxxx xxx v xxxxxxx, xx mu v xôxxxxxx xxxxxxxxx xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie peňažnej xxxxxx xxxxx obeti xx výška bodového xxxxxxxxxxx xxxxxxx (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) xxxxxxxxxxxx xxxxx 100 xxxxx. Xx xxxx xx xxxxxxxx xx osoba xxxxxxxxx xx obeti, ktorá x dôsledku trestného xxxx xxxxxxx, ak xxxx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x zároveň v xxxx xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxxxx, ktorej xxxxxxx xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx prekluzívnu (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx obeť dozvedela x xxxxx spôsobenej xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx xxx xxxxxxxxx trestného xxxx, xxxx xxxxxxxx okamžik, xxxx xx to xxxxx. Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx po uplynutí xxxxxxxxxx lehoty.

- Pomoc xx xx xxxxxxx xxxxx, ktorej x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx xx xxxxxx, poskytne x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx náklady xxxxxxx x xxxxxxxx, xxxxxxx o xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; pomoc xx xxxxxx súčte xxxxxx xxxxxxxxxx xxxx 150 000.- Xx. Xx xxxx - xx xxx, xxx jej poskytli xxxxx - xxxxxxxx, xx xxx xxxxxxxxx xxxxx je xxxxxx xxx xx, xxxxx xxxx podkladom xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx v xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx až xx xxxxxxxxxx xxxxx 150&xxxx;000.- Kč; xxxxxx xx prihliadne xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, xxxxx je xxxxxxxxxx xx obeti, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela (xx bola xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx xxxxx s xxx xxxx x xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx xxxxxx), xx poskytne xxxxxxx xxxxx x xxxxxxxxx xxxx 150 000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Kč, x ak xx xxxxx xxxxx xxxx xxx tri xxxxx, xxxxxxxxxxx čiastka sa xxx xxxxxx xxxxx xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx inštitút xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx poistenie zodpovednosti. Xxxxx xx xxxxxxxx x záležitostiach dopravných xxxôx žiadať subjekt, xxxxx xxxxxxxx poistenie xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx xxxxxxx. Xxx x xxxxxx ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx xx možné xxxxxx ministerstvo xxxxxxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Pripomíname, xx xx nevyhnutné xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, na xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Xx xxx xxxxxxxľ xxxxxxx, xxxxxxxxxxxx spravodlivosti xxxôxx xxxxxxx xxxxxxx. Xx xxxxxx xxxxxxxxxx x xxxxxxx ani xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx byť xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx xxxxx xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx bude xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ je xx xxxxxxx xxxxx odo xxx xxxxxxxxxxx xxxxxx xxxxxxx na účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) až xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx mu škodu xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx peňažnej pomoci. Xx xxxxxx postup xxôxxxxxxx sociálna situácia xxxxx, xxxxxxx xxxxx xxxxx, ktorú jej xxôxxxxxx, a výška xxxxxxx, ktorú obeť xxxxxxx.