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Please save a copy of this form locally before filling it in using Adobe Reader,
then print it and post it to the Court. RON - 2014/1
Formular de cerere
Precizri cu privire la acest formular de cerere Avertisment : Cererea dumneavoastr nu va fi acceptat dac este
Prezentul formular este un document juridic oficial i v incomplet (articolul 47 din Regulamentul Curii). De reinut, n mod
poate afecta drepturile i obligaiile. Pentru a-l completa, special, c articolul 47 paragraful 2 a) din Regulament prevede c :
trebuie s urmai instruciunile care figureaz n Toate elementele citate la alineatele d) pn la f) ale paragrafului 1
documentul Cum se completeaz formularul de cerere. [expunerea faptelor, nclcrile pretinse ale Conveniei i
Asigurai-v c ai completat toate rubricile care se refer informaiile cu privire la respectarea criteriilor de admisibilitate]
la situaia dumneavoastr i c ai anexat toate trebuie s fie prezentate n partea corespunztoare a formularului
documentele pertinente. 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 Dac ai primit deja din partea Curii un numr de referin
Omului un lot de etichete cu coduri de bare, lipii una din pentru aceste capete de cerere, indicai-l n rubrica de mai jos.
acestea n rubrica de mai jos.

A. Reclamant (persoan fizic) B. Reclamant (organizaie)


Aceast rubric privete doar reclamanii persoane fizice. Aceast rubric trebuie completat doar dac reclamantul este o societate,
Trecei la rubrica B dac reclamantul este o organizaie. organizaie neguvernamental, asociaie sau orice alt entitate juridic.
1. Nume 9. Nume

2. Prenume
10. Numr de nregistrare (dac este cazul)

3. Data naterii
ex. 27/09/2012 11. Data nregistrrii sau nfiinrii (dac este cazul)
Z Z L L A A A A ex. 27/09/2012
4. Cetenie Z Z L L A A A A
12. Domeniu de activitate

5. Adres
13. Sediu

6. Telefon (inclusiv prefixul rii)

7. E-mail (dac este cazul)


14. Telefon (inclusiv prefixul rii)

8. Sex
masculin 15. E-mail

feminin
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 Avocat


unei organizaii
Completai aceast parte a formularului dac l reprezentai pe Completai aceast parte a formularului dac l reprezentai
reclamant ns nu suntei avocat. pe reclamant n calitate de avocat.
Explicai n rubrica de mai jos n ce calitate l reprezentai pe 24. Nume
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 25. Prenume

17. Nume 26. Cetenie

18. Prenume 27. Adres

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
Z Z L L A A A A
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 LIE - Liechtenstein

ARM - Armenia LTU - Lituania

AUT - Austria LUX - Luxemburg

AZE - Azerbaidjan LVA - Letonia

BEL - Belgia MCO - Monaco

BGR - Bulgaria MDA - Republica Moldova

BIH - Bosnia i Heregovina MKD - Fosta Republic Iugoslav a Macedoniei

CHE - Elveia 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 invocat Explicaie
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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 9/11

39. Dispunei sau ai dispus de o cale de recurs pe care nu ai exercitat-o? 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 Da
internaionale de anchet sau reglementare a diferendelor?
Nu

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

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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 Z L L A A A A

Reclamantul (reclamanii) sau reprezentantul (reprezentanii) acestuia (acestora) trebuie s semneze formularul n chenarul de mai jos.
48. Semntur (semnturi) Reclamant (Reclamani) Reprezentant (Reprezentani) Bifai opiunea corespunztoare

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