COUR EUROPENNE DES DROITS DE LHOMME EUROPEAN COURT OF HUMAN RIGHTS CURTEA EUROPEANA A DREPTURILOR OMULUI

Conseil de lEurope - Council of Europe-Consiliul Europei Strasbourg, France

REQUTE APPLICATION CERERE

prsente en application de larticle 34 de la Convention europenne des Droits de lHomme, ainsi que des articles 45 et 47 du Rglement de la Cour under Article 34 of the European Convention on Human Rights and Rules 45 and 47 of the Rules of Court prezentat n conformitate cu articolul 34 al Conveniei Europene a Drepturilor Omului, precum i cu articolele 45 i 47 ale Regulamentului Curii

IMPORTANT:

La prsente requte 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. Prezenta cerere este un document juridic i poate afecta drepturile i obligaiile dumneavoastr.

-2ILES PARTIES THE PARTIES PARTILE

LE REQURANT/LA REQURANTE THE APPLICANT RECLAMANTUL/RECLAMANTA (Renseignements fournir concernant le/la requrant(e) et son/sa reprsentant(e) ventuel(le)) (Fill in the following details of the applicant and the representative, if any) (Informaii cu privire la reclamant/reclamant i eventualul/a su reprezentant/reprezentant)

A.

1.

Nom de famille . 2. Prnom (s) . Surname First name (s) Nume Prenume Sexe: Sex: Sex: masculin/fminin male/female masculin/feminin 4. Profession Occupation Profesia

3.

Nationalit .. Nationality Cetenie

5.

Date et lieu de naissance . Date and place of birth Data i locul naterii Domicile .. Permanent address Domiciliul Tel. N Adresse actuelle (si diffrente de 6.) ... Present address (if different from 6.) Adresa actual (dac difer de 6) Nom et prnom du/de la reprsentant(e)* ... Name of representative* Numele i prenumele reprezentantului/reprezentantei* Profession du/de la reprsentant(e) . Occupation of representative Ocupaia reprezentantului/reprezentantei Adresse du/de la reprsentant(e) . Address of representative Adresa reprezentantului/reprezentantei Tel. N Fax N

6.

7. 8.

9.

10.

11.

12.
B.

LA HAUTE PARTIE CONTRACTANTE THE HIGH CONTRACTING PARTY INALTA PARTE CONTRACTANTA (Indiquer ci-aprs le nom de lEtat/des Etats contre le(s)quel(s) la requte est dirige) (Fill in the name of the State(s) against which the application is directed)

(Indicai aici numele Statului/Statelor mpotriva cruia/crora introducei cererea)

-313. ..........................................................................................................................................................................................
* Si le/la requrant(e) est reprsent(e), joindre une procuration signe par le/la requrant(e) en faveur du/de la reprsentant(e). A form of authority signed by the applicant should be submitted if a representative is appointed. Dac reclamantul/reclamanta este reprezentat/, a se anexa o procur semnat de reclamant/ n favoarea reprezentantului/reprezentantei.

__________

-4II EXPOS DES FAITS STATEMENT OF THE FACTS EXPUNEREA FAPTELOR

(Voir chapitre II de la note explicative) (See Part II of the Explanatory Note) (A se vedea Partea a II-a a Notiei Explicative)

14.

Si ncessaire, continuer sur une feuille spare Continue on a separate sheet if necessary Dac este necesar, continuai pe o fil separat

-5III EXPOS DE LA OU DES VIOLATION(S) DE LA CONVENTION ET/OU DES PROTOCOLES ALLGUE(S), AINSI QUE DES ARGUMENTS LAPPUI STATEMENT OF ALLEGED VIOLATION(S) OF THE CONVENTION AND/OR PROTOCOLS AND OF RELEVANT ARGUMENTS EXPUNEREA PRETINSEI SAU A PRETINSELOR VIOLARII ALE CONVENTIEI SI/SAU A PROTOCOALELOR, PRECUM SI A ARGUMENTELOR IN SPRIJINUL ACESTOR AFIRMATII
(Voir chapitre III de la note explicative) (See Part III of the Explanatory Note) (A se vedea Partea a III-a a Notiei Explicative)

15.

-6IV EXPOS RELATIF AUX PRESCRIPTIONS DE LARTICLE 35 1 DE LA CONVENTION STATEMENT RELATIVE TO ARTICLE 35 1 OF THE CONVENTION EXPUNERE IN LEGATURA CU PREVEDERILE ARTICOLULUI 35 1 DIN CONVENTIE
(Voir chapitre IV de la note explicative. Donner pour chaque grief, et au besoin sur une feuille spare, les renseignements demands sous les points 16 18 ci-aprs) (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) (A se vedea capitolul IV al notiei explicative. A se prezenta pentru fiecare capt de cerere, i dac este nevoie pe o fil separat, informaiile cerute la punctele 16 pn la 18 de mai jos)

16.

Dcision interne dfinitive (date et nature de la dcision, organe - judiciaire ou autre layant rendue) Final decision (date, court or authority and nature of decision) Decizia intern definitiv (data i natura deciziei, organul - judiciar sau altul - care a pronunat-o)

17.

Autres dcisions (numres dans l=ordre chronologique en indiquant, pour chaque dcision, sa date, sa nature et lorgane judiciaire ou autre layant rendue) Other decisions (list in chronological order, giving date, court or authority and nature of decision for each of them) Alte decizii (enumerate n ordine cronologic, indicnd, pentru fiecare decizie, data, natura i organul - judiciar sau altul care a pronunat-o)

18.

Dispos(i)ez-vous dun recours que vous n'avez pas exerc? Si oui, lequel et pour quel motif na-t-il pas t exerc? 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. Dispunei sau ai dispus de un recurs pe care nu l-ai exercitat? Dac da, care i pentru ce motiv acesta nu a fost exercitat?

Si ncessaire, continuer sur une feuille spare Continue on a separate sheet if necessary Dac este necesar, continuai pe o fil separat

-7VEXPOS DE L'OBJET DE LA REQUTE STATEMENT OF THE OBJECT OF THE APPLICATION EXPUNEREA OBIECTULUI CERERII
(Voir chapitre V de la note explicative) (See Part V of the Explanatory Note) (A se vedea capitolul V din notia explicativ)

19.

VI -

AUTRES INSTANCES INTERNATIONALES TRAITANT OU AYANT TRAIT LAFFAIRE STATEMENT CONCERNING OTHER INTERNATIONAL PROCEEDINGS ALTE INSTANTE INTERNATIONALE CARE EXAMINEAZA SAU AU EXAMINAT CAZUL
(Voir chapitre VI de la note explicative) (See Part VI of the Explanatory Note) (A se vedea capitolul VI al notiei explicative)

20.

Avez-vous soumis une autre instance internationale denqute ou de rglement les griefs noncs dans la prsente requte? Si oui, fournir des indications dtailles ce sujet. Have you submitted the above complaints to any other procedure of international investigation or settlement? If so, give full details. Ai prezentat n faa unei alte instane internaionale de anchet sau reglementare capetele de cerere din prezenta plngere? Dac da, furnizai indicaii detaliate cu privire la acest aspect.

-8VII. PICES ANNEXES (PAS DORIGINAUX, UNIQUEMENT DES COPIES, PRIRE DE N'UTILISER NI AGRAFE, NI ADHSIF, NI LIEN D'AUCUNE SORTE) (NO ORIGINAL DOCUMENTS, ONLY PHOTOCOPIES, DO NOT STAPLE, TAPE OR BIND DOCUMENTS) (NU TRIMITETI ORIGINALE, CI NUMAI COPII ; FR A LE CAPSA, LIPI SAU LEGA)

LIST OF DOCUMENTS

LISTA DOCUMENTELOR

(Voir chapitre VII de la note explicative. Joindre copie de toutes les dcisions mentionnes sous ch. IV et VI ci-dessus. Se procurer, au besoin, les copies ncessaires, et, en cas dimpossibilit, expliquer pourquoi celles-ci ne peuvent pas tre obtenues. Ces documents ne vous seront pas retourns.) (See Part VII of the Explanatory Note. Include copies of all decisions referred 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.) (A se vedea capitolul VII al notiei explicative. Anexai copii ale tuturor deciziilor menionate la cap. IV i VI de mai sus. Dac nu avei copii, va trebui s le obinei. Dac nu le putei obine, explicai din ce motive. Aceste documente nu v vor fi napoiate).

21.

a)................................................................................................................................................................................................ b)................................................................................................................................................................................................ c)................................................................................................................................................................................................

-9VIII - DCLARATION ET SIGNATURE DECLARATION AND SIGNATURE DECLARATIA SI SEMNATURA

(Voir chapitre VIII de la note explicative) (See Part VIII of the Explanatory Note) (A se vedea capitolul VIII al notiei explicative)

22.

Je dclare en toute conscience et loyaut que les renseignements qui figurent sur la prsente formule de requte 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. Declar pe onoare c informaiile ce figureaz n prezentul formular de cerere sunt exacte.

Lieu/Place/Locul............................................................................................... Date/Date /Data.................................................................................................

(Signature du/de la requrant(e) ou du/de la reprsentant(e)) (Signature of the applicant or of the representative) (Semntura reclamantului/ei sau a reprezentantului/ei)