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RON 2014/1

Formular de
cerere
Precizri cu privire la acest
formular de cerere
Prezentul formular este un document juridic
oficial i v poate afecta drepturile i
obligaiile. Pentru a-l completa, trebuie s
urmai instruciunile care figureaz n
documentul Cum se completeaz formularul
de cerere. Asigurai-v c ai completat toate
rubricile care se refer la situaia
dumneavoastr i c ai anexat toate
documentele pertinente.

Avertisment : Cererea dumneavoastr nu va fi acceptat


dac este incomplet (articolul 47 din Regulamentul
Curii). De reinut, n mod special, c articolul 47
paragraful 2 a) din Regulament prevede c :

Toate elementele citate la alineatele d) pn la f)


ale paragrafului 1 [expunerea faptelor, nclcrile
pretinse ale Conveniei i informaiile cu privire la
respectarea criteriilor de admisibilitate] trebuie s
fie prezentate n partea corespunztoare a
formularului de cerere i trebuie s fie suficiente,
pentru a permite Curii s determine natura i
obiectul cererii fr a necesita consultarea altor
documente.

Etichete cu coduri de bare

Numr de referin

Dac ai primit deja din partea Curii Europene


a Drepturilor Omului un lot de etichete cu
coduri de bare, lipii una din acestea n rubrica
de mai jos.

Dac ai primit deja din partea Curii un numr de


referin pentru aceste capete de cerere, indicai-l n
rubrica de mai jos.

A Reclamant (persoan fizic)


.
Aceast rubric privete doar reclamanii
persoane fizice.
Trecei la rubrica B dac reclamantul este o
organizaie.
1. Nume

B. Reclamant (organizaie)
Aceast rubric trebuie completat doar dac
reclamantul este o societate,
organizaie neguvernamental, asociaie sau orice
alt entitate juridic.
9. Nume

2. Prenume (toate)
10. Numr de nregistrare (dac este cazul)
3. Data naterii
ex.
27
Z

4. Ceteni
e

/09/2012

11. Data nregistrrii sau nfiinrii (dac


este cazul)

A
Z

12. Domeniu de activitate


5. Adres
13. Sediu

ex.
27/09/2012

6. Telefon (inclusiv prefixul rii)

7. E-mail (dac este cazul)


14. Telefon (inclusiv prefixul rii)
8. Sex
masculin
feminin

15. E-mail

Curtea European a Drepturilor Omului Formular de cerere

2/11

C. Reprezentantul (Reprezentanii) reclamantului


Dac reclamantul nu este reprezentat, trecei la rubrica D.

Reprezentant care nu este avocat /


Reprezentant al
unei organizaii

Avocat

Completai aceast parte a formularului dac l


reprezentai pe
reclamant ns nu suntei avocat.
Explicai n rubrica de mai jos n ce calitate l
reprezentai pe
reclamant sau ce legtur avei cu acesta ori, dac
este vorba de
o organizaie, ce funcie oficial ocupai n cadrul
acesteia.
16 Calitate / legtur / funcie
.

Completai aceast parte a formularului dac l


reprezentai
pe reclamant n calitate de avocat.
24 Nume
.

17 Nume
.

26 Cetenie
.

18 Prenume
.

27 Adres
.

25 Prenume
.

19. Cetenie

20. Adres
28. Telefon (inclusiv prefixul rii)

29. Fax

21. Telefon (inclusiv prefixul rii)

30. E-mail

22. Fax

23. E-mail

Procur
Reclamantul trebuie s l mputerniceasc pe reprezentant s acioneze n numele su, semnnd
formularul de procur de mai jos
(a se vedea documentul Cum se completeaz formularul de cerere).
Prin prezenta mputernicesc persoana desemnat mai sus n scopul de a m reprezenta n
procedura n faa Curii Europene a Drepturilor Omului n legtur cu cererea pe care am introdus-o,
n baza articolului 34 al Conveniei.

31. Semntura reclamantului

32. Data

ex.
27/09/2012

Curtea European a Drepturilor Omului Formular de cerere

3/11

D. Statul (Statele) mpotriva cruia (crora) introducei cererea


33. Bifai rubrica (rubricile) corespunztoare Statului (Statelor) mpotriva cruia (crora) introducei cererea.

ALB - Albania

ITA - Italia

AND - Andora
ARM - Armenia

LIE - Liechtenstein
LTU - Lituania

AUT - Austria

LUX - Luxemburg

AZE - Azerbaidjan

LVA - Letonia

BEL - Belgia

MCO - Monaco

BGR - Bulgaria

MDA - Republica Moldova

BIH - Bosnia i Heregovina


CHE - Elveia

MKD - Fosta Republic Iugoslav a


Macedoniei
MLT - Malta

CYP - Cipru

MNE - Muntenegru

CZE - Republica Ceh

NLD - Olanda

DEU - Germania

NOR - Norvegia

DNK - Danemarca

POL - Polonia

ESP - Spania

PRT - Portugalia

EST - Estonia

ROU - Romnia

FIN - Finlanda

RUS - Federaia Rus

FRA - Frana

SMR - San Marino

GBR - Marea Britanie

SRB - Serbia

GEO - Georgia

SVK - Republica Slovac

GRC - Grecia

SVN - Slovenia

HRV - Croaia

SWE - Suedia

HUN - Ungaria

TUR - Turcia

IRL - Irlanda

UKR - Ucraina

ISL - Islanda

Curtea European a Drepturilor Omului Formular de cerere

4/11

Obiectul cererii
Toate informaiile referitoare la fapte, capetele de cerere i respectarea de ctre reclamant a
cerinelor epuizrii cilor de recurs interne i a termenului de ase luni (articolul 35 paragraful 1
din Convenie) trebuie s figureze la rubricile E, F i G ale formularului de cerere (articolul 47
paragraful 2 a) din Regulamentul Curii). Reclamantul are posibilitatea de a completa aceste
informaii anexnd la formularul de cerere un document de maximum 20 de pagini (articolul 47
paragraful 2 b) din Regulament). n acest numr de pagini nu sunt incluse deciziile i
documentele anexate la formular.

E. Expunerea faptelor
34.

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La completarea acestei rubrici, asigurai-v c v limitai la spaiul prevzut n acest scop. Adaptai
textul n consecin. n cazul n care dorii s transmitei informaii suplimentare, consultai documentul
Cum se completeaz formularul de cerere.

Curtea European a Drepturilor Omului Formular de cerere

5/11

Expunerea faptelor (continuare)


35.

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La completarea acestei rubrici, asigurai-v c v limitai la spaiul prevzut n acest scop. Adaptai
textul n consecin. n cazul n care dorii s transmitei informaii suplimentare, consultai
documentul Cum se completeaz formularul de cerere .

Curtea European a Drepturilor Omului Formular de cerere

6/11

Expunerea faptelor (continuare)


36.

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La completarea acestei rubrici, asigurai-v c v limitai la spaiul prevzut n acest scop. Adaptai
textul n consecin. n cazul n care dorii s transmitei informaii suplimentare, consultai
documentul Cum se completeaz formularul de cerere .

Curtea European a Drepturilor Omului Formular de cerere

7/11

F. Expunerea pretinselor nclcri ale Conveniei i/sau ale Protocoalelor, precum i a


argumentelor n sprijinul acestor afirmaii
37. Articol
Explicaie
invocat

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Curtea European a Drepturilor Omului Formular de cerere

8/11

G. Confirmai, pentru fiecare capt de cerere, c ai epuizat toate cile de recurs disponibile n statul n
cauz, inclusiv orice cale de atac (apel i/sau recurs); indicai, de asemenea, data la care decizia
intern definitiv/irevocabil a fost pronunat, precum i data la care a

existat posibilitatea de a lua cunotin de textul integral al acestei decizii, pentru a face dovada
respectrii termenului de ase luni.

38. Capt de cerere

Ci de recurs exercitate i data deciziei definitive/irevocabile

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Curtea European a Drepturilor Omului Formular de cerere


39. Dispunei sau ai dispus de o cale de recurs pe care nu ai exercitat-o?

9/11
Da
Nu

40. Dac ai rspuns afirmativ, menionai ce cale de recurs nu ai exercitat i pentru ce motiv nu ai fcut-o.

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H. Informaii cu privire la alte instane internaionale care examineaz sau au


examinat cererea (dac este cazul)
41. Reclamantul a prezentat oricare dintre aceste capete de cerere n faa unei alte instane
internaionale de anchet sau reglementare a diferendelor?
N
u

Da

42. Dac ai rspuns afirmativ, descriei procedura n mod concis (capetele de cerere prezentate, numele
instanei internaionale, data i natura eventualelor decizii luate).

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43. Reclamantul a mai introdus pn acum una sau mai multe cereri n faa
Curii?

D
a
Nu

44. Dac ai rspuns afirmativ, indicai n rubrica urmtoare numrul (numerele) cererii (cererilor) respective.

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Curtea European a Drepturilor Omului Formular de cerere

10/11

I. Lista documentelor anexate


Trebuie s anexai copii integrale i lizibile ale tuturor documentelor.
Niciun document nu v va fi restituit. Prin urmare, este n interesul dumneavoastr s
transmitei Curii copii, i nu originale.
TREBUIE:
- s clasai documentele n funcie de dat i procedur,
- s numerotai paginile n mod consecutiv,
- s NU capsai, legai sau lipii documentele.
.

45. Indicai n rubrica de mai jos, n ordine cronologic, documentele anexate la formularul de cerere, cu o
scurt descriere a acestora.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.

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Curtea European a Drepturilor Omului Formular de cerere

11/11

Alte observaii
Avei alte observaii de formulat cu privire la cererea
dumneavoastr? 46. Observaii

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Declaraia i semntura
Declar pe onoare i n deplin cunotin de cauz c informaiile ce figureaz n prezentul
formular de cerere sunt exacte. 47. Data
ex. 27/09/2012
Z

Reclamantul (reclamanii) sau reprezentantul (reprezentanii) acestuia (acestora) trebuie s semneze


formularul n chenarul de mai jos.
48. Semntur (semnturi)
corespunztoare

Reclamant (Reclamani)

Reprezentant (Reprezentani) Bifai opiunea

Desemnarea persoanei cu care se poart corespondena


n cazul n care sunt mai muli reclamani sau reprezentani, indicai numele i adresa unei singure
persoane cu care Curtea va purta corespondena.
49. Numele i adresa
reclamantului
reprezentantului Bifai opiunea corespunztoare

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Formularul de cerere
completat trebuie semnat i
trimis prin pot la
urmtoarea adres :
Monsieur le Greffier de la
Cour europenne des droits de
lhomme Conseil de lEurope
67075 STRASBOURG CEDEX

FRANCE