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LIT - 2014/1

Pareiškimo formuliaras

Apie šį pareiškimo formuliarą Šis pareiškimo formuliaras yra oficialus teisinis dokumentas ir gali turėti įtakos Jūsų teisėms bei pareigoms. Pildydami šį formuliarą vadovaukitės Atmintinėje pateiktomis taisyklėmis. Prieš siųsdami įsitikinkite, ar užpildėte visus formuliaro laukus ir pateikėte visus reikiamus dokumentus.

Įspėjimas: Jeigu Jūsų pareiškimo formuliaras nėra visiškai užpildytas, jis nebus priimtas (žr. Teismo Reglamento 47 taisyklę). Atkreipkite dėmesį į tai, kad 47 taisyklės 2 dalies (a) punkte nurodoma, jog pareiškėjas turi pateikti „visą informaciją, paminėtą ankščiau išvardytos 1 dalies (d)–(f) punktuose [faktų santrauka, galimi pažeidimai ir informacija, įrodanti, kad buvo įvykdyti priimtinumo kriterijai], kuri turėtų būti išdėstyta atitinkamose pareiškimo formuliaro dalyse ir suteiktų galimybę Teismui suprasti pareiškimo esmę, neieškant šios informacijos kituose dokumentuose“.

A. Pareiškėjas(-a) (fizinis asmuo) Ši dalis skirta tik pareiškėjams, kurie yra fiziniai asmenys. Jeigu pareiškėjas yra juridinis asmuo ar organizacija, prašom pildyti B dalį.

B. Pareiškėjas(-a) (organizacija arba juridinis asmuo)Ši dalis turėtų būti pildoma tik tais atvejais, kai pareiškėjas yra įmonė, NVO, asociacija ar kitas juridinis asmuo.

1. Pavardė

2. Vardas(-ai)

3. Gimimo data

4. Pilietybė

5. Adresas

6. Telefono numeris (su tarptautiniu kodu)

7. Elektroninio pašto adresas (jei turite)

8. Lytis

vyras

moteris

9. Pavadinimas

11. Registracijos ar įsteigimo data (jei turite)

12. Veiklos pobūdis

13. Adresas, kuriuo įregistruota organizacija


15. Elektroninio pašto adresas

D D M M M M M M

Pavyzdys: 27/09/2012 D D M M M M M M

Pavyzdys: 27/09/2012

ŽymaJeigu turite Jūsų skundams suteiktą žymos numerį, prašom nurodyti jį toliau esančiame langelyje.

10. Registracijos numeris (jei turite)

Brūkšninio kodo etiketėJeigu jau esate gavę brūkšninio kodo etikečių iš Europos Žmogaus Teisių Teismo, prašom vieną jų užklijuoti ant toliau esančio langelio.

Europos Žmogaus Teisių Teismas – pareiškimo formuliaras 2/11

C. Pareiškėjo atstovas(-ai) Jeigu pareiškėjas neturi atstovo, pereiti į D dalį.

Teisininkas Prašom užpildyti šią formuliaro dalį, jeigu atstovaujate pareiškėjui ir esate teisininkas.

Toliau esančiame langelyje paaiškinkite, kaip Jūs atstovaujate pareiškėjui arba nurodykite santykį su pareiškėju. Jeigu atstovaujate organizacijai, nurodykite savo oficialias pareigas joje.

16. Ryšys/santykis/pareigos

17. Pavardė

18. Vardas(-ai)

19. Pilietybė

20. Adresas


22. Fakso numeris


24. Pavardė

25. Pavardė

26. Pilietybė

27. Adresas


29. Fakso numeris


Įgaliojimas Pareiškėjas, norėdamas įgalioti bet kurį atstovą veikti jo ar jos vardu, turi pasirašyti įgaliojimą, esantį toliau (žr. pareiškimo formuliaro pildymo atmintinę).

Įgalioju nurodytą asmenį atstovauti man Europos Žmogaus Teisių Teismo proceso metu, kiek tai susiję su mano pareiškimu, pateiktu pagal Konvencijos 34 straipsnį.

31. Pareiškėjo(-s) parašas 32. Data

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Prašom užpildyti šią formuliaro dalį, jeigu atstovaujate pareiškėjui, bet nesate teisininkas.

Atstovas nėra teisininkas. Atstovas yra organizacijos darbuotojas


D. Valstybė(-s), prieš kurią(-ias) pateikiate pareiškimą

33. Pažymėkite varnele tą valstybę (tas valstybes), prieš kurią (kurias) pateikiate savo pareiškimą

ALB - Albanija ITA - Italija

AND - Andora LIE - Lichtenšteinas

ARM - Armėnija

AUT - Austrija LUX - Liuksemburgas

AZE - Azerbaidžanas LVA - Latvija

BEL - Belgija MCO - Monakas

BGR - Bulgarija MDA - Moldova

BIH - Bosnija ir Hercegovina MKD - Buvusioji Jugoslavijos Respublika Makedonija

CHE - Šveicarija MLT - Malta

CYP - Kipras MNE - Juodkalnija

CZE - Čekija NLD - Nyderlandai

DEU - Vokietija NOR - Norvegija

DNK - Danija POL - Lenkija

ESP - Ispanija PRT - Portugalija

EST - Estija ROU - Rumunija

FIN - Suomija RUS - Rusija

FRA - Prancūzija SMR - San Marinas

GBR - Jungtinė Karalystė SRB - Serbija

GEO - Gruzija SVK - Slovakija

GRC - Graikija SVN - Slovėnija

HRV - Kroatija SWE - Švedija

HUN - Vengrija TUR - Turkija

IRL - Airija UKR - Ukraina

ISL - Islandija

LTU - Lietuva


Pareiškimo tikslasE, F ir G dalyse turi būti pateikti faktai, skundai bei informacija apie tai, ar buvo išnaudotos visos teisių gynimo priemonės valstybės viduje, ir ar pareiškimas pateiktas per 6 mėnesius nuo galutinio sprendimo datos, kaip nurodyta Konvencijos 35 straipsnio 1 dalyje (Teismo Reglamento 47 taisyklės 2 dalies (a) punktas). Pareiškėjas gali papildomai pateikti detalią informaciją, bet šie papildomi paaiškinimai neturėtų viršyti 20 puslapių (47 taisyklės 2 dalies (b) punktas). Šie 20 puslapių neapima pridedamų dokumentų ar sprendimų kopijų.

E. Faktų santrauka 34.

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Faktų santrauka (tęsinys)35.

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Faktų santrauka (tęsinys)36.

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F. Tariamų Konvencijos ir/ar jos protokolų pažeidimų bei pagrindžiančių argumentų santrauka 37. Konvencijos straipsnis Paaiškinimas

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G. Prašom patvirtinti, kad kiekvieno skundo atveju išnaudojote visas vidaus teisinės gynybos priemones, įskaitant ir sprendimo apskundimąinstancine tvarka, toje šalyje (šalyse), prieš kurią (kurias) yra nukreiptas Jūsų pareiškimas. Nurodykite datas, kada buvo priimtas galutinis sprendimas bei kada jį gavote. Ši informacija yra svarbi norint įrodyti, kad pareiškimas pateiktas per privalomą šešių mėnesių laikotarpį.

38. Skundas Informacija apie išnaudotas teisinės gynybos priemones ir galutinio sprendimo data

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39. Ar yra (buvo) kokių nors kitų apskundimo būdų ar teisinių gynybos galimybių, kurių neišnaudojote? Taip

Ne

40. Jeigu į 39 klausimą atsakėte „taip“, nurodykite kokių apskundimo būdų ar teisinių gynybos galimybių neišnaudojote ir paaiškinkite, kodėl to nepadarėte?

H. Procesai kitose tarptautinėse institucijose (jei tokių buvo)

41. Ar kada nors kreipėtės į kitą tarptautinę instituciją dėl šiame pareiškime nurodyto(-ų)skundo(-ų) nagrinėjimo ar sprendimo?

Taip

Ne

42.

43. Taip

Ne

44. Jeigu į 43 klausimą atsakėte „taip“, toliau esančiame langelyje nurodykite pareiškimo(-ų) numerį(-ius).

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Jeigu į 41 klausimą atsakėte „taip“, pateikite trumpą informaciją apie procesą (kokie skundai buvo pateikti, tarptautinės institucijos pavadinimą, šios institucijos sprendimą, jo datą).

Ar Jūs (pareiškėjas(-a)) šiuo metu esate ar anksčiau buvote pateikęs(-usi) skundą(-ų) Europos Žmogaus Teisių Teismui?


I. Pridedamų dokumentų sąrašas Prašom pridėti įskaitomas ir pilnas dokumentų kopijas.Dokumentai Jums nebus grąžinti, todėl prašom pateikti ne originalius dokumentus, o jų kopijas. Jūs PRIVALOTE:

- išdėstyti dokumentus pagal datą ir procesą;- iš eilės sunumeruoti puslapius;- dokumentų nesusegti, nesurišti ar nesuklijuoti.

45. Toliau esančiuose laukeliuose prašom pateikti dokumentų sąrašą chronologine tvarka bei trumpai aprašyti dokumentus.

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Kitos pastabos Ar turite kitų pastabų dėl savo pareiškimo?

46. Pastabos

Patvirtinimas ir parašas Patvirtinu, kad, mano žiniomis ir įsitikinimu, šiame pareiškimo formuliare pateikta informacija yra teisinga.

47. Data

Pareiškėjas(-ai) ar pareiškėjo atstovas(-ai) turi pasirašyti toliau esančiame langelyje.

48. Parašas(-ai)

Kontaktinė susirašinėjimo informacijaJeigu yra daugiau nei vienas pareiškėjas ar atstovas, nurodykite vardą, pavardę bei adresą to žmogaus, su kuriuo Teismas susirašinės.

49. Pareiškėjo Atstovo (pažymėkite tinkamą) vardas, pavardė ir adresas:

Užpildytas pareiškimo formuliaras turi būti pasirašytas ir išsiųstas paštu toliau nurodytu adresu:

The Registrar European Court of Human RightsCouncil of Europe 67075 STRASBOURG CEDEXFRANCE

D D M M M M M M

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Pareiškėjas(-ai)


Atstovas(-ai) – pažymėkite tinkamą

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35: 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: Button2: LawyerSurname: NonLawyerCapacity: LawyerFirstName: NonLawyerSurname: LawyerNationality: NonLawyerFirstNames: NonLawyerNationality: LawyerAddress: NonLawyerAddress: LawyerTelephone: LawyerFax: NonLawyerTelephone: LawyerEmail: NonLawyerFax: NonLawyerEmail: Albania: OffAndorra: OffArmenia: OffAustria: OffAzerbaijan: OffBelgium: OffBosnia and Herzegovina: OffBulgaria: OffCroatia: OffCyprus: OffCzech Republic: OffDenmark: OffEstonia: OffFinland: OffFrance: OffGeorgia: OffGermany: OffGreece: OffHungary: OffIceland: OffIreland: OffItaly: OffLatvia: OffLiechtenstein: OffLithuania: OffLuxembourg: OffMalta: OffRepublic of Moldova: OffMonaco: OffMontenegro: OffThe Netherlands: OffNorway: OffPoland: OffPortugal: OffRomania: OffRussian Federation: OffSan Marino: OffSerbia: OffSlovak Republic: OffSlovenia: OffSpain: OffSweden: OffSwitzerland: OffThe former Yugoslav Republic of Macedonia: OffTurkey: OffUkraine: OffUnited Kingdom: OffStatesBinary: 034: Remedy: InternationalBody: ApplicationNumbers: 46 Comments: DeclarationDate: ApplicantAddress: SignatureDate: Version: LIT - 2014/1OrganisationAddress: OrganisationDateOfReg: ApplicantDateOfBirth: Sex: 0Appeal: OffComplaint: OffPendingApplications: OffApplicantNationality: ApplicantTelephone: ApplicantEmail: OrganisationEmail: 38 Complaint: ComplaintInfo: 37 Article invoked: Explanation: RefNo: ApplicantFirstNames: ApplicantSurname: OrganisationID: OrganisationName: OrganisationTelephone: OrganisationActivity: 36: Text1: Pateikiama informacija turi tilpti šiuose trijuose puslapiuose, todėl peržiūrėkite tekstą prieš siųsdami pareiškimo formuliarą.Jei norite pateikti papildomą informaciją, atsižvelkite į „Pareiškimo formuliaro pildymo atmintinės“ nuostatas.48 signed: Off49 Correspondent: OffWarning: Please note that this form will work correctly only with Adobe Reader 9 Upwards (download available from www.adobe.com). Please save a copy of this form locally before filling it in using Adobe Reader, then print it and post it to the Court.49 Name and address of applicant representative tick as appropriate:

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