Designs Forms And Languages Of The Eu For Assistance To Victims Of Crime

Original Language Title: vzory formulářů a jazyky států EU pro pomoc obětem trestných činů

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225/2013 Sb.



The DECREE



of 24 June. July 2013,



laying down the models of the forms and languages of the Member States of the European

the Union used in cross-border cases, the granting of financial assistance

victims of crime



The Ministry of Justice provides under section 49 (a). and (e))) up to Act No.

45/2013 Coll., on victims of crime and amending some laws (law

the victims of criminal offences):



§ 1



This Decree lays down the



and the pattern of the application form) on the granting of financial assistance in cross-border

cases,



(b)) model of form for the transmission of applications for financial assistance in the

cross-border cases,



(c)) model of form for passing judgment on the application for the grant of

financial assistance in cross-border cases,



(d)), other than the official languages, in which they follow requests for

financial assistance and their annexes, additional information and a list of

all ceded documents, requests for additional information and

information according to § 36 odst. 2 the law on victims of crime,



(e)) the official languages of the other Member States of the European Union, which will

The Department of Justice to receive requests for the granting of financial

help, attachments and additional information, where appropriate, the list of

all ceded documents.



§ 2



(1) the model application form for the granting of financial assistance in the

cross-border cases are set out in Appendix 1 of this order.



(2) a model form for the transmission of applications for the granting of financial assistance in the

cross-border cases are set out in annex 2 of this order.



(3) a model form for the transmission of the decision on the application for the grant of

financial assistance in cross-border cases are set out in annex No. 3

of this order.



§ 3



Other than the official languages, in which they follow requests for

financial assistance and their annexes, additional information and a list of

all ceded documents, requests for additional information and

information according to § 36 odst. 2 the law on victims of crime, are

listed in annex 4 of this order.



§ 4



The Ministry of Justice in cross-border cases the request for

the granting of financial assistance, their attachments and additional information

Alternatively, a list of all the documents in the Slovak also ceded and

the English language.



§ 5



This Decree shall take effect on 1 January 2005. August 2013.



Secretary:



Mgr. B in r.



Annex 1



THE APPLICATION FOR THE GRANTING OF FINANCIAL ASSISTANCE IN CROSS-BORDER CASES



For the purposes of providing financial assistance to victims of crime, fill in the

Please following form. Follow the instructions when filling out and

the explanatory notes set out at the end of this application.



+------+----------------------------------------------------------------------------------------------+

| I. | Fill out the personal information about the applicant, legibly-crime victim: |

+------+----------------------------------------------------------------------------------------------+

| 1. | Last name: |

+------+----------------------------------------------------------------------------------------------+

| 2. | The name, eg. name: |

+------+----------------------------------------------------------------------------------------------+

| 3. | Date of birth: |

+------+----------------------------------------------------------------------------------------------+

| 4. | Address: |

| | |

+------+----------------------------------------------------------------------------------------------+

| 5. | Correspondence address (if different from the address of residence): |

| | |

+------+----------------------------------------------------------------------------------------------+

| 6. | Phone: |

| | (* optional) |

+------+----------------------------------------------------------------------------------------------+

| 7. | Email: |

| | (* optional) |

+------+----------------------------------------------------------------------------------------------+

| 8. | Nationality: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| II. | If the applicant is represented by another person, fill in the information of the representatives. |

| | At the same time attach the instrument showing the emergence of representation. |

+------+----------------------------------------------------------------------------------------------+

| 1. | Last name: |

+------+----------------------------------------------------------------------------------------------+

| 2. | The name, eg. name: |

+------+----------------------------------------------------------------------------------------------+

| 3. | Address: |

| | |

+------+----------------------------------------------------------------------------------------------+

| 4. | Correspondence address (if different from the address of residence): |

| | |

+------+----------------------------------------------------------------------------------------------+

| 5. | Legal representation: reason |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| III. | In the event that the applicant is a person of the survivor of a victim that the crime |

| | She died, also fill in details of the deceased. |

| | Attach document confirming the death of the victim. |

+------+----------------------------------------------------------------------------------------------+

| 1. | Last name: |

+------+----------------------------------------------------------------------------------------------+

| 2. | The name, eg. name: |

+------+----------------------------------------------------------------------------------------------+

| 3. | Date of birth: |

+------+----------------------------------------------------------------------------------------------+

| 4. | Date of death: |

+------+----------------------------------------------------------------------------------------------+

| 5. | The last address of residence: |

| | |

+------+----------------------------------------------------------------------------------------------+

| 6. | Nationality: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| IV. | Please provide information about the relationship between the applicant (person of the survivor of a victim, which as a result |

| | crime and victim of that) as a result of crime. |

| | Please attach documents proving this relationship. |

+------+----------------------------------------------------------------------------------------------+

| 1. | Indicate whether the applicant has been registered by a parent, spouse, partner, child, or which sibling |

| | the victim, who died as a result of a crime, and at the time of her death the victims of žilv |

| | in the home: |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+

| 2. | Please indicate whether the victim who died as a result of the crime, was obliged to poskytovalanebo |

| | provide the applicant: nutrition |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+

| 3. | Indicate whether the applicant is the only person that meets the above conditions, or whether there are |

| | and other persons who fulfil these conditions. Please indicate the number, if You know: |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| In. | Please indicate the fact proving the relationship of the victim to a Member State of the Union, and these |

| | facts please. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| VI. | Please provide information about the last decision authority participating in criminal proceedings and decisions |

| | attach. |

| | If you cannot attach such a decision, indicate the authority of trestnímřízení |

| | last dealing with the crime (including the file tags). At the same time give information about |

| | a person suspected of having committed a criminal offence, if it is known to you. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |
| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| VII. | Indicate the date when the offence was committed and when you learned about the occurrence and extent of the damage |

| | or non-material damage caused by this Act. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| VIII. | Please indicate whether and how you have filed a claim for compensation for the damage, the injury to nebonemajetkové |

| | the offender or another person for damage or non-material damage. At the same time indicate |

| | whether and to what extent you have damage or moral damage, replaced. |

| | Enclose documents proving the facts. |

| | This item need not be completed if the offender has not been identified. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| IX. | Describe your property and the Ministry, and indicate how the ratios have changed as a result of committing |

| | of the offence. |

| | Also enclose documents proving the facts. |

| | Evidence of assets, it is possible to replace the affidavit. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+-----------------------------------------------------------------------------------------------------+

| * Points X. to XIII. fill in, if you become the victim of a crime, the harm to the kterýmVám |

|-health, or was caused by a heavy injury. |

+------+----------------------------------------------------------------------------------------------+

| X. | Please indicate, when it started and ended Your incapacity caused by the criminal offence. |

| | To the application, please attach a medical report showing the damage to health and the length of work |

| | the inability of the. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| XI. | Please indicate whether you are applying for financial assistance in the amount of the flat-rate amounts, or whether the Rep |

| | the amount of the lost wages and the cost of treatment. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+-----------------------------------------------------------------------------------------------------+

| * If you decide to apply for financial assistance in the amount of the flat-rate amounts, you |

| fill in paragraphs XII. and XIII. request. |

+------+----------------------------------------------------------------------------------------------+

| XII. | Please indicate the amount of the costs associated with treatment. |

| | Please attach documents proving this amount. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| XIII. | Please indicate the amount of health insurance benefits or invalidity pension and the amount of time after injury |

| | to health caused by the criminal offence for which the applicant is receiving or has received. |

| | Please attach documents proving the loss of earnings, the amount of health insurance benefits or |

| | invalidity pension. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+-----------------------------------------------------------------------------------------------------+

| Point XIV. fill in, if it is the applicant who has suffered non-material damage, the victim of a criminal offence against |

| human dignity in the sexual area or a child, which is the victim of a crime of torturing |

| of the person. |

+------+----------------------------------------------------------------------------------------------+

| XIV. | Please indicate the amount of the costs incurred for professional psychotherapy, physiotherapy or other training |

| | services focused on the remedy arising out of non-material injury. |

| | Please attach documents proving the amount of these costs. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| XV. | Please indicate whether you are applying to point out financial assistance through postal services |

| | or by transfer to the account; in this case, please provide your account number. |

+------+----------------------------------------------------------------------------------------------+

| | |

| | |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



An affidavit of the applicant for financial assistance under Act No. 45/2013

Coll., on victims of crime and amending some laws:



I hereby declare that the information given in this application match

the fact.



I declare that my property are such that a criminal offence,

I was a victim, the social situation has worsened. Property or

moral injury caused by me in this way has not yet been fully settled.



I declare that I am entitled to financial assistance or similar claim for

compensation for the injury caused by the criminal offence involving me,/and in any

another State than in the Czech Republic.



I note that my claim for compensation or reparation for the

non-material damage, which I'm against the offenders, pursuant to the provisions

section 33 of Act No. 45/2013 Coll., on victims of crime and amending

Some laws, the Czech Republic, and to the extent provided by

financial assistance.



I also note that the deliberate placing of an incorrect or incomplete

the data or its zatajením in order to obtain undue advantage I can

commit an offence pursuant to the provisions of § 21. 1 (a). (c)) Law No.

200/1990 Coll. on offences, as amended. Also I take

Note that the unauthorized acquisition of financial assistance can be

classified as a fulfillment of the constituent elements of the offence of fraud

in accordance with the provisions of section 209 of the Act No. 40/2009 Coll., the criminal code, in the

as amended.



..........................

Name and signature of the applicant/s



Annex 2



FORM FOR THE TRANSMISSION OF APPLICATIONS FOR THE GRANTING OF FINANCIAL ASSISTANCE IN THE

CROSS-BORDER CASES



(article 6, paragraph 2, of Directive 2004/80/EC)



+------+----------------------------------------------------------------------------------------------+

| 1. | Reference number: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 2. | The language of the application and supporting documents (article 6, paragraph 3, of Directive 2004/80/EC):

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 3. | The authority transmitting application: |

| | Details of the assistance (transferring) Authority: |

| |----------------------------------------------------------------------------------------------+

| | Member State: |
| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Contact person or the Department responsible for handling the matter: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 4. | The recipient requests: |

| | Information about crucial (receiving) body: |

| |----------------------------------------------------------------------------------------------+

| | Member State: |

| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 5. | Data on applicants for financial assistance: |

| |----------------------------------------------------------------------------------------------+

| | Last name: |

| |----------------------------------------------------------------------------------------------+

| | Name: |

| |----------------------------------------------------------------------------------------------+

| | Sex: |

| |----------------------------------------------------------------------------------------------+

| | Date of birth: |

| |----------------------------------------------------------------------------------------------+

| | Nationality: |

| |----------------------------------------------------------------------------------------------+

| | Address and postal code: |

| | |

| |----------------------------------------------------------------------------------------------+

| | The place where a person has a usual residence (if different from place of residence): |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

| |----------------------------------------------------------------------------------------------+

| | Bank details (for the purpose of the transfer must be bankyuveden the code instead of the code BIC and |

| | instead of account number IBAN number must be indicated): |

| | |

| | BIC: |

| | |

| | IBAN: |

| | |

| | Bank name: |

| | |

| | Contact abroad: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Any legal representation: |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 6. | Information about the victims, if the application is made by any other person: |

| |----------------------------------------------------------------------------------------------+

| | Last name: |

| |----------------------------------------------------------------------------------------------+

| | Name: |

| |----------------------------------------------------------------------------------------------+

| | Sex: |

| |----------------------------------------------------------------------------------------------+

| | Date of birth: |

| |----------------------------------------------------------------------------------------------+

| | Nationality: |

| |----------------------------------------------------------------------------------------------+

| | Address and postal code: |

| | |

| |----------------------------------------------------------------------------------------------+

| | The place where a person has a usual residence (if different from place of residence): |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 7. | List of attached documents: |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



Made in:



Of the day:



The authority which made the request:

(signature and/or stamp)



CONFIRMATION OF RECEIPT OF THE APPLICATION



(article 7 of the Directive 2004/80/EC) ^ 1



(For sending to the assisting authority and to the applicant)



+------+----------------------------------------------------------------------------------------------+

| 1. | The determining authority: |

| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Member State: |

| |----------------------------------------------------------------------------------------------+

| | Reference number: |

| |----------------------------------------------------------------------------------------------+

| | Contact person or the Department responsible for handling the matter: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 2. | If possible, an indication of the approximate time of the adoption of the decision on the application (article 7 (b), (c)) |

| | Directive 2004/80/EC):

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 3. | This confirms the receipt of the request passed to the assisting authority: |

| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Member State: |

| |----------------------------------------------------------------------------------------------+

| | Reference number: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 4. | The date of receipt of the application: |

+------+----------------------------------------------------------------------------------------------+



Made in:



Of the day:



The authority which made the request:

(signature and/or stamp)



Annex 3



FORM FOR THE TRANSMISSION OF THE DECISION ON THE APPLICATION FOR THE GRANTING OF FINANCIAL

Assistance in CROSS-BORDER SITUATIONS (article 10 of Directive 2004/80/EC)
(article 10 of Directive 2004/80/EC)

+------+----------------------------------------------------------------------------------------------+

| 1. | Reference number: |

+------+----------------------------------------------------------------------------------------------+

| 2. | Date of adoption of the decision: |

+------+----------------------------------------------------------------------------------------------+

| 3. | The language of the decision: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 4. | The transferring authority of the decision: |

| | Information about crucial (transferring) Authority: |

| |----------------------------------------------------------------------------------------------+

| | Member State: |

| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Contact person or the Department responsible for handling the matter: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 5. | The recipient requests: |

| | Details of the assistance (entrance): |

| |----------------------------------------------------------------------------------------------+

| | Member State: |

| |----------------------------------------------------------------------------------------------+

| | The name of the authority: |

| |----------------------------------------------------------------------------------------------+

| | Contact person or the Department responsible for handling the matter: |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 6. | The decision relates to: |

| | Information about the applicant: |

| |----------------------------------------------------------------------------------------------+

| | Name of applicant: |

| |----------------------------------------------------------------------------------------------+

| | Address: |

| | |

| |----------------------------------------------------------------------------------------------+

| | Nationality: |

| |----------------------------------------------------------------------------------------------+

| | Phone (including codes): |

| |----------------------------------------------------------------------------------------------+

| | Fax: |

| |----------------------------------------------------------------------------------------------+

| | Email: |

| |----------------------------------------------------------------------------------------------+

| | Any legal representation: |

+------+----------------------------------------------------------------------------------------------+



+------+----------------------------------------------------------------------------------------------+

| 7. | Details of the decision: |

| | This information shall be granted, without prejudice to the text of the decision. |

| |----------------------------------------------------------------------------------------------+

| | and) Summary: |

| | |

| | |

| | |

| |----------------------------------------------------------------------------------------------+

| | (b)) about the possibility of filing an appeal, the competent authority and of the time limits: |

| | |

| | |

| | |

| |----------------------------------------------------------------------------------------------+

| | (c)) for more information or steps that the applicant take |

| | (to be completed if necessary): |

| | |

| | |

| | |

+------+----------------------------------------------------------------------------------------------+



Made in:



Of the day:



The authority which made the request:

(signature and/or stamp)



Annex 4



OTHER THAN THE OFFICIAL LANGUAGES, IN WHICH THE MEMBER STATES OF THE EUROPEAN UNION ADOPTED

REQUESTS FOR HELP



+-----------------------------+-----------------------------+

| The Member State of the European Union | Languages other than the official |

+-----------------------------+-----------------------------+

| Austria | English |

+-----------------------------+-----------------------------+

| Belgium | English |

+-----------------------------+-----------------------------+

| Bulgaria | English |

+-----------------------------+-----------------------------+

| Croatia | --- |

+-----------------------------+-----------------------------+

| Cyprus | --- |

+-----------------------------+-----------------------------+

| Denmark | English |

+-----------------------------+-----------------------------+

| Estonia | accepts applications in all |

| | the official languages of the EU |

+-----------------------------+-----------------------------+

| Finland | English |

+-----------------------------+-----------------------------+

| France | --- |

+-----------------------------+-----------------------------+

| Germany | accepts applications in all |

| | the official languages of the EU |

+-----------------------------+-----------------------------+

| Greece | --- |

+-----------------------------+-----------------------------+

| Hungary | English |

+-----------------------------+-----------------------------+

| Italy | --- |

+-----------------------------+-----------------------------+

| Ireland | French |

+-----------------------------+-----------------------------+

| Lithuania | English |

+-----------------------------+-----------------------------+

| Latvia | English |

+-----------------------------+-----------------------------+

| Luxembourg | --- |

+-----------------------------+-----------------------------+

| Malta | --- |

+-----------------------------+-----------------------------+

| Netherlands | English |

+-----------------------------+-----------------------------+

| Poland | English |

+-----------------------------+-----------------------------+

| Portugal | English |

+-----------------------------+-----------------------------+

| Romania | English |

| | French |

+-----------------------------+-----------------------------+

| Slovakia | --- |

+-----------------------------+-----------------------------+

| Slovenia | --- |

+-----------------------------+-----------------------------+

| Spain | --- |

+-----------------------------+-----------------------------+

| Sweden | English |

+-----------------------------+-----------------------------+

| United Kingdom | French |

| | German |

+-----------------------------+-----------------------------+



1) the decision-making authority may use a similar form or another way

the acknowledgement of receipt, if it meets the conditions of article 7 of the directive.

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