COUR EUROPEENNE DES DROITS DE L’HOMME
EUROPEAN COURT OF HUMAN RIGHTS
AVRUPA İNSAN HAKLARI MAHKEMESİ

Conseil de l’Europe – Council of Europe – Avrupa Konseyi
Strasbourg, France

REQUÊTE
APPLICATION
BAŞVURU

présentée en application de l’article 34 de la Convention europeenne des Droits de l’Homme,
ainsi que des articles 45 et 47 du Règlement de la Cour

underArticle 34 of the European Convention on Human Rights
and Rules 45 and 47 of the Rules of Court

Avrupa İnsan Hakları Sözleşmesi’nin 34. ve Mahkeme İç Tüzüğü’nün
45 ve 47. maddeleri uyarınca sunulmuştur.

     IMPORTANT: La présente requête est un document juridique et peut affecter vos droits et obligations.
This application is a formal legal document and may affect your rights and obligations.
Bu başvuru hukuki bir belgedir ve hak ve yükümlülüklerinizi etkileyebilir.

I-    LES PARTIES
THE PARTIES
TARAFLAR

A. LE REQUÉRANT/LA REQUERANTE
THE APPLİCANT
 BAŞVURUCU
(Renseignements à fournir concernant le requérant/la requérante et son/sa represantant(e) éventuel(le)
(Fill in the following details of the applicant and the represantative, If any)
(Başvurucu ve varsa temsilcisi hakkında verilmesi gereken bilgiler)

1.  (Nom de familie/ Surname)
 Soyadı…………………………………………
 2. (Prénom (s)/ First name (s))
Adı……………………………………………..
(Sexe: masculin/feminin
Sex: male/female)
Cinsiyeti: erkek/kadın
 
3. (Nationalité/Nationality)
Milliyeti……………………………………
4.(Profession/Occupation)
Mesleği……………………………………..
5. (Date et lieu naissance/Date and Place of birth)
Doğum tarihi ve yeri ………………………………………………..
5.(Domicile/Permanent address)
İkametgahı …………………………………………..
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7.   Tel. No………………………………… 8.   (Adresse actuelle (si diffêrente de 6.)/ Present address (if different from 6.))
Şu anki adresi (6’da belirtilen ikametgahından farklı ise) ……………………..
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9.   (Nom et prénom du/de la représentant(e)/ Name of represantative)
Temsilcinin adı…………………………………
10. (Profession du/de la représentant(e)/Occupation of represantative)
Temsilcinin mesleği………………………………….
11.( Adresse du/de la représentant(e)/ Adress of represantative)
Temsilcinin adresi……………………………..
12. Tel No…………………………………………………
Fax No……………………………………………………..
  1. LA HAUTE PARTIE CONTRACTANTE
    THE HIGH CONTRACTING PARTY
      YÜKSEK SÖZLEŞMECİ TARAF

    (Indiquer ci-après le nom de l’Etat/des Etats contre le(s)quel(s) la requète est dirigée)
    (Fill in the name of the State(s) against which the application is directed)
    (Aşağıda başvurunun hangi devlet aleyhine yöneltildiğini belirtiniz.

    13. …………………………………………………………………………………………………………………………..

(*) Si le/la requérant(e) est represanté(e), joindre une procuration signée par le/la requérant(e) en faveur dulde la représentant(e)       A form of authority signed by the applicant should be submitted it a reprasentative is appointed.
Eğer başvurucu temsil ediliyorsa, temsilciyi vekil atayan ve başvurucunun imzasını taşıyan bir Yetki Belgesi ekleyiniz.

II- EXPOSÉ DES FAITS
STATEMENT OF THE FACTS
OLAYLARA İLİŞKİN AÇIKLAMA
(Voir chapitre II de la note explicative)
(See Part II of the Explanatory Note)
(Açıklayıcı Not’un II. Bölümüne bakınız)
14

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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

III-  EXPOSÉ DE LA OU DES VIOLATION(S) DE LA CONVENTION ET/OU DES PROTOCOLES ALLÉGUÉE(S), AINSI QUE DES ARGUMENTS Â L’APPUI
STATEMENT OF ALLEGED VIOLATION(S) OF THE CONVENTION AND/OR PROTOCOLS AND OF RELEVANT ARGUMENTS
BAŞVURUCU TARAFINDAN ÖNE SÜRÜLEN SÖZLEŞME VE PROTOKOL İHLALLERİ İLE İDDİALARIN DAYANAKLARINA İLİŞKİN AÇIKLAMA
(Voir chapitre III de la note explicative)
(See Part II of the Explanatory Note)
(Açıklayıcı Not’ta III. Bölüme bakınız)
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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

III-  EXPOSÉ DE LA OU DES VIOLATION(S) DE LA CONVENTION ET/OU DES PROT

IV-  EXPOSÉ RELATIF AUX PRESCRIPTIONS DE L’ARTICLE 35 § 1 DE LA CONVENTION
STATEMENT RELATIVE TO ARTICLE 35 § 1 OF THE CONVENTION
SÖZLEŞMENİN 35. MADDESİNİN 1. FIKRASINA İLİŞKİN AÇIKLAMA
(Voir chapitre IV de la note explicative. Donner pour chaque grief, et au besoin sur une  feuille séparée, les renseignements demandés sous les points 16 a 18 ci-apres)
(See Part IV of the Explanatory Note. If necessary, give the details mentioned below under points 16 to 18 on a separate sheet for each separate complaint)
(Açıklayıcı Not’un IV. Bölümüne bakınız. Her şikayet için, gerektiğinde ayrı bir sayfa kullanarak, aşağıda 16’da 18’e kadar numaralanmış alt bölümlerde istenen bilgileri veriniz)

16. Décision interne définitive (date et-natura de la décision, organe – judiciaire ou autre – l’ayant rendue)
Final decision (date, court or authority and nature of decision)
 Nihai karar (kararın tarihi, niteliği, Kararı veren merci -adli veya diğer-)

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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

  1. Autres décisions (énumérées dans l’ordre chronologique en indiquant, pour chaque décision, sa date, sa nature et l’organe -judiciaire ou autre- l’ayant rendue)
    Other decisions (list in chronological order, giving date, court or authority and nature of decision for each of them)
      Diğer kararlar (tarih sırasına göre her kararın tarihi, niteliği ve kararı veren merci -adli veya diğer- belirtilmelidir.)

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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

  1. Dipos(i)ez-vous d’un recours que vous n’avez pas exercé? Si oui, lequel et pour quel motif n’a-t-il pas été exercé?
    Is there or was there any other appeal or other remedy available to you which you have not used.
    If so, explain why you have not used it.
     Başvurmadığınız başka bir çözüm yolu var mı? Eğer varsa, nedir ve neden bu yola
    başvurulmadı?

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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

.
V-    EXPOSÉ DE L’OBJET DE LA REQUÈTE ET PRÉTENTIONS PROVISOIRES POUR UNE SATISFACTION EQUITABLE
STATEMENT OF THE OBJECT OF THE APPLICATION AND PROVISIONAL CLAIMS FOR JUST SATISFACION
  BAŞVURUNUN AMACINA VE HAKKANİYETE UYGUN TATMİN TALEPLERİNE İLİŞKİN AÇIKLAMA
(Voir chapitre V de la note explicative)
(See pat V of the Explanatory Note)
(Açıklayıcı Not’un V. Bölümüne bakınız.)
19.
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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

VI-  AUTRES INSTANCES INTERNATIONALES TRAITANT OU AYANT TRAITÉ L’AFFAIRE
STATEMENT CONCERNING OTHER INTERNATIONAL PROCEEDINGS
DİĞER ULUSLARARASI MAKAMLAR ÖNÜNDEKİ USULLERE İLİŞKİN AÇIKLAMA
(Voir chapitre VI de la note explicative)
(See Part VI of the Explanatory Note)
(Açıklayıcı Not’un VI. Bölümüne ilişkin açıklama)

20. Avez-vous soumis à une autre instance internationale d’enquéte ou de règlement les griefs énoncés dans la présente requète? Si oui, fournir des indications détalilées à ce sujet.
Have you submitted the above complaints to any other procedure of international investigation or settlement? If so, give full details.
  Bu başvurunuzdaki şikayetlerinizi başka bir uluslararası makama sundunuz mu?
Eğer sunduysanız, bu konuda ayrıntılı bilgi veriniz.

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Si nécessaire, continuer sur une feuille séparée
Continue on a separate sheet if necessary
Eğer gerekli görüyorsanız ayrı bir sayfada devam edebilirsiniz.

VII- PIÈCES ANNEXÉES (PAS D’ORIGINAUX, UNIQUEMENT DES COPIES)
LIST OF DOCUMENTS (NO ORIGINAL  ONLY PHOTOCOPIES)
BELGELER LİSTESİ  (BELGELERİN ASLI  DEĞİL SADECE ÖRNEKLERİ)  

(Voir chapitre VII de la note explicative, joindre copie de toutes les décisions mentionnées sous ch. V et VI ci-dessus. Se procurer, au besoin, les copies nécessaires, et, en cas d’impossibilité, expliquer pourquoi ceiles-ci ne peuvent pas ètre obtenuès. Ces documents ne vous seront pes retcurnès.)
(See Part VII of the Explanatory Note. Include copies of all decisions refered to in Parts IV and VI above. If you do not have copies, you should obtain them. If you cannot obtain them, explain why not. No documents will be returned to you.)
(Açıklayıcı Not’un VII. Bölümüne bakınız. Yukardaki IV ve VI. alt bölümlerde belirtilen bütün kararların örneğini ekleyiniz. Eğer bu belgeler elinizde yoksa temin ediniz. Eğer temin edemiyorsanız bunun nedenini açıklayınız. Gönderdiğiniz belgeler size geri verilmeyecektir.)

21.  a)………………………………………………………………………………………………………………………..
b)………………………………………………………………………………………………………………………..
c)……………………………………………………………………………………………………………………….

 

VIII- DÉCLARATION ET SIGNATURE
DECLARATION AND SIGNATURE
 BİLDİRİM VE İMZA
(Voir chapitre VIII de la note explicative)
(See Part VIII of the Explanatory Note)
(Açıklayıcı Not’un VIII. Bölümüne bakınız)

22. Je déclare en toute conscience et loyauté que les renseignements qui figurent sur la présente formule de requète sont exacts.
I hereby declare that, to the best of my knowledge and belief, the information I have given in the present application form is correct.
 Bu başvuru formunda vermiş olduğum bilgilerin doğru olduğunu bilgim ve inancım
dahilinde beyan ederim.

Lieu/Place /Yer………………………………………………………………
Date/Date /Tarih…………………………………………………………….

(Signature du/de la requérant(e) ou du/de la représentant(e))
(Signature of the appilcant or of the representative)
(Başvurucunun veya temsilcinin imzası)

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