Cabinet of Ministers Regulations No. 543 Riga, 27 June 2006 (pr. No 34 54) rules on the State compensation application form issued in accordance with the law "on State compensation to victims" article 8, first subparagraph, the rules establishing the State compensation application form (annex), which the victim submitted to the legal aid administration to receive State compensation. Prime Minister a. Halloween Justice Minister g. Grīnvald annex Cabinet 27 June 2006 regulations No 543 State compensation request to the legal aid administration 1 Person who wants to receive State compensation for violent offence would cause damage (note. If the victim of their rights is implemented through a representative, request form fill in his name and representative, indicating the victim's data, but this request stating in point 6 1.1.-1.6. data referred to in paragraph about yourself) 1.1. name _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 1.2. ID code _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 1.3. passport data _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (series, number, date of issue, issuing authority) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ _____ 1.4. nationality ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 1.5. residence address _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 1.6. phone and other contact information _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. Date by which a person recognised as a victim _____. _____. _____ _____ (dd/mm/yyyy) (note. State compensation request is made within one year after the day the person recognised as a victim) 3. Supporting reasons, if submission of overdue (Note: this paragraph is completed, if there is an overdue statutory deadline for submitting the request) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 4. information about the person who died as a result of a crime, if the crime targeted the person's life (indicate name, surname, personal code, as well as the exact degree of relationship with the victim) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ __ 5. Previously received compensation for violent criminal as a result of injury (to fill in all the boxes below. If the loss were not reimbursed, you must specify "no refunds". If the loss has been compensated, indicate the amount of compensation, compensate the person name and surname or name of the authority is rewarded. The request shall be accompanied by a document attesting payment) 5.1 losses voluntarily rewarded violent crime blamed on the person (a person who has committed a violent or criminal offences in accordance with the laws and is responsible for the conduct of the perpetrator) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ __ 5.2 loss rewarded violent crime blamed on the person of the enforcement order (specify the judicial authority, the judge's name, surname, date of execution, the number, the artist name) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ _ _____ _____ _____ _____ _____ _____ ___ 5.3. amount of compensation paid in advance together ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ 6. additional compensation payment of ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ _____ 7. requesting bank details: Bank name ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ code account number 8. Request documents to be added: 88.1. a certificate to a driver of the process _____ ____ page (s) 8.2. entry into force of the process of transforming a final judgment on the ___ ___ page (s) (attached to the judgment of the Court of Justice or the Prosecutor's statement on the fine, if criminal proceedings have been completed, or the process of transforming the decision on termination of the criminal proceedings, the person does not reabilitējoš reasons) 8.3. copy of the document to the __ _____ (s) of the page (Plug-in, if the Court judgment or the final ruling of the promoters of the process victim in criminal proceedings or civil procedure reimbursement of prescribed offence would cause damage is not, or not fully met) 8.4. document confirming the refund paid in advance on the amount of _____ pages (s) (specify that document is attached) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ 8.5. power of Attorney certifying the applicant's right to make a request on behalf of the victim, to ____ ____ page (s) (if you want to add a victim your rights enforced by the representative) 8.6. document which certifies that the submission of overdue for good reasons (plug-in, if you fill in paragraph 3) ___ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ Certifies that the refund requested was not received. I certify that all the information in the application is correct and complete. I agree that the administration of legal aid can be checked in the veracity of the data specified in the request and get to me related information to fulfil this request. I am aware that (a) the legal aid administration's contentious agenda piedz my paid State compensation if the application deliberately false information.

.

(applicant's name).
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(applicant's signature) (fill in date of application).

(date of receipt of the request, the recipient's job title, first name, last name and signature)


The Minister of Justice of g. Grīnvald