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Anayasa Mahkemesi Bireysel Başvuru Formu


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T.C.

ANAYASA MAHKEMESİ

BİREYSEL BAŞVURU FORMU

Anayasa Mahkemesi İçtüzüğünün 59. maddeleri hükümlerine göre hazırlanmıştır.

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BİREYSEL BAŞVURU FORMU
I- KİŞİSEL BİLGİLER
A- GERÇEK KİŞİLER İÇİN
BAŞVURUCUNUN
1- T.C. KİMLİK NUMARASI :
2- ADI:.............................................. 3 - SOYADI :....................................................
4- CİNSİYETİ: ERKEK : KADIN :
5- UYRUĞU :....................................................
6- MESLEĞİ :.................................................... GÜN AY YIL
7- DOĞUM YERİ VE TARİHİ :...........................,
8- YAZIŞMA ADRESİ:................................................................................................
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9- TELEFON NUMARASI VE ELEKTRONİK POSTA ADRESİ
a- EV :....................................................
b- İŞ :....................................................
c- CEP :....................................................
ç- ELEKTRONİK POSTA ADRESİ :............................................................
AVUKATININ
1- ADI:.............................................. 2 - SOYADI :....................................................
3- YAZIŞMA ADRESİ:................................................................................................
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4- TELEFON NUMARASI VE ELEKTRONİK POSTA ADRESİ
a- EV :....................................................
b- İŞ :....................................................
c- CEP :....................................................
ç- ELEKTRONİK POSTA ADRESİ :............................................................
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B- TÜZEL KİŞİLER İÇİN
BAŞVURUCUNUN
1- UNVANI : ............................................................................................................
2- ADRESİ :..............................................................................................................
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TEMSİLE YETKİLİ KİŞİNİN
1- T.C. KİMLİK NUMARASI:
2- ADI:.............................................. 3 - SOYADI :....................................................
4- UYRUĞU :....................................................
5- MESLEĞİ :.................................................... GÜN AY YIL
6- DOĞUM YERİ VE TARİHİ :...........................,
7- YAZIŞMA ADRESİ:................................................................................................
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8- TELEFON NUMARASI VE ELEKTRONİK POSTA ADRESİ
a- EV :....................................................
b- İŞ :....................................................
c- CEP :....................................................
ç- ELEKTRONİK POSTA ADRESİ :............................................................
AVUKATININ
1- ADI:.............................................. 2 - SOYADI :....................................................
3- YAZIŞMA ADRESİ:................................................................................................
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4- TELEFON NUMARASI VE ELEKTRONİK POSTA ADRESİ
a- EV :....................................................
b- İŞ :....................................................
c- CEP :....................................................
ç- ELEKTRONİK POSTA ADRESİ :............................................................
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II- AÇIKLAMALAR
A- Kamu gücünün işlem, eylem ya da ihmaline dair olayların tarih sırasına göre özeti:
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B- Bireysel başvuru kapsamındaki haklardan hangisinin hangi nedenlerle ihlal
edildiği ve buna ilişkin gerekçeler ve delillere ait özlü açıklamalar:
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C- Başvurucunun güncel ve kişisel bir temel hakkının doğrudan zedelendiği iddiasının
açıklanması:
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III- BAŞVURU YOLLARININ TÜKETİLDİĞİNE İLİŞKİN BİLGİLER
A- Başvuru yollarının tüketilmesine ilişkin aşamalar:
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B- Başvuru yollarının tüketildiği veya başvuru yolu öngörülmemişse ihlalin
öğrenildiği tarih:
1- KARARI VEREN MAHKEME/MERCİİ/ MAKAM :...............................................
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2- KARARIN TARİHİ VE SAYISI:..................................................................................
3- TEBLİĞ VEYA ÖĞRENME TARİHİ :........................................................................
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C- Başvuru mazeret nedeniyle süresi içinde yapılamamışsa buna dair açıklamalar:
1- MAZERET NEDENİ :............................................................................................
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2- MAZERETİN BAŞLANGIÇ VE BİTİŞ TARİHİ
a- BAŞLANGIÇ TARİHİ :
b- BİTİŞ TARİHİ :
3- MAZERETE İLİŞKİN BELGELER : .................................................................
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IV- DİĞER BİLGİLER
A- Başvurucunun Anayasa Mahkemesi önünde devam eden bir başka başvurusu varsa
numarası: .............................................................................................................................
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B- Başvurucunun kamuya açık belgelerde kimliğinin gizli tutulması talebi ve bunun
gerekçesi:
1-TALEBİ YOK :
2-TALEBİ VAR :
GEREKÇESİ : ...............................................................................................
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V- SONUÇ TALEPLERİ
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Bu başvuru formunda vermiş olduğum bilgilerin doğru olduğunu; formda
belirtilen bilgilerde, adreslerimde veya başvuruyla ilgili koşullarda herhangi bir
değişiklik meydana geldiğinde Mahkemeye bildireceğimi beyan ederim.
Başvurucu : ................................................. Temsilcisi/Avukatı :..........................................
Tarih :
İmza :
EKLER
1- Yetki belgesi veya vekâletname
2- Başvuru harcının ödendiğine dair belge
3- Nüfus cüzdanı örneği, başvurucu yabancı ise geçerli kimlik belgesi
4- Tüzel kişilerde tüzel kişiliği temsile yetki belgesi
5- Kesin karar ya da işlemin tebliğ belgesi
6- Dayanılan belgelerin asılları ya da onaylı örnekleri
7- Tazminat talebi varsa uğranılan zarar ve miktarı ile buna ilişkin belgeler
8- Başvuru süresinde yapılamamışsa mazereti ispatlayan belgeler
Başvurucu ihlal iddiasına dayanak gösterilen belgelere erişememişse bunun nedenleri ve gerekçeleri
Dosya Arşivi>>Diğer Dosyalar
21.07.2013 20:36
2581 Okunma



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