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Evropski sud za ljudska pravaEuropean Court of Human Rights

Savet Evrope

Strazbur, Francuska

Council of EuropeStrasbourg, France

PREDSTAVKAAPPLICATION

na osnovu lana 34 Evropske konvencije o ljudskim pravimai Pravila br. 45 i 47 Poslovnika Suda

under Article 34 of the European Convention on Human Rightsand Rules 45 and 47 of the Rules of Court

VANO:

Ova predstavka je formalni pravni dokument i moe uticati na vaa prava i obaveze.

IMPORTANT:

This application is a formal legal document and may affect your rights and obligations.

I. STRANKETHE PARTIES

A. PODNOSILAC PREDSTAVKETHE APPLICANT

(Popuniti podatke podnosioca predstavke i zastupnika, ukoliko ga ima)(Fill in the following details of the applicant and the representative, if any)

1. Prezime ........................................... 2. Ime(na) .................................................Surname First name(s)

Pol: muki/enskiSex: male/female

3. Dravljanstvo.............................................. 4. Zanimanje .............................................. Nationality Occupation

5. Datum i mesto roenja ......................................................................................................Date and place of birth

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6. Adresa prebivalita ...........................................................................................................Permanent address

7. Telefon ..............................................................................................................................Tel. No.

8. Adresa boravita ..............................................................................................................

(ako je razliita od one pod takom 6)

Present address (if different from the one in line 6)

9. Ime zastupnika ..................................................................................................................Name of representative

10. Zanimanje zastupnika ....................................................................................................Occupation of representative

11. Adresa zastupnika ........................................................................................................Address of representative

12. Telefon ........................................... Faks ................................................Tel. No. Fax No.

B. VISOKA STRANA UGOVORNICATHE HIGH CONTRACTING PARTY

(Popuniti ime drave(a) protiv koje(ih) se podnosi predstavka(Fill in the name of the State(s) against which the application is directed)

13. ..........................................................................................................................................

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II. IZJAVA O INJENICAMASTATEMENT OF THE FACTS

14.

Nastaviti na posebnom papiru,, ukoliko je potrebnoContinue on a separate sheet if necessary

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III. IZJAVA O NAVODNOM(IM) KRENJU(IMA)KONVENCIJE I/ILI PROTOKOLA I O BITNIMARGUMENTIMASTATEMENT OF ALLEGED VIOLATION(S) OFTHE CONVENTION AND / OR PROTOCOLSAND OF RELEVANT ARGUMENTS

15.

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IV. IZJAVA U VEZI LANA 35, STAV 1 KONVENCIJESTATEMENT RELATIVE TO ARTICLE 35 1 OF THE CONVENTION

(Ukoliko je potrebno, za svaku posebno dati podatke u takama od 16 do 18 na posebnompapiru)

(If necessary, give the details mentioned below under points 16 to 18 on a separate sheet foreach separate complaint)

16. Pravosnana odluka.......................................................................................................(datum, sud ili organ i priroda odluke)Final decision(date, court or authority and nature of decision)

17. Druge odluke .................................................................................................................(navesti hronoloki redom, datum, sudili drugi organ i priroda svake odluke)Other decisions (list in chronological order,giving date, court or authority and natureof decision for each of them)

18. Da li postoji neki drugi pravni lek koji Vam stoji na raspolaganju a koji niste upotrebili?Ako postoji, objasnite zbog ega ga niste upotrebili?

Is there or was there any other appeal or other remedy available to you which you have notused?

If so, explain why you have not used it

Nastaviti na posebnom papiru,, ukoliko je potrebnoContinue on a separate sheet if necessary

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V. IZJAVA O CILJU PODNESKA I OKVIRNI ZAHTEV ZA PRAVINOZADOVOLJENJESTATEMENT OF THE OBJECT OF THE APPLICATIONAND PROVISIONAL CLAIMS FOR JUST SATISFACTION

19.

Linkovi.htm

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VI. IZJAVA O OSTALIM MEUNARODNIM PROSTUPCIMASTATEMENT CONCERNING OTHER INTERNATIONAL PROCEEDINGS

20. Da li ste podneli gore navedene albe nekom drugom sistemu meunarodne istrageili poravnanja. Ako jeste, napiite pune podatke

Have you submitted the above complaints to any other procedure of international investigationor settlement? If so, give full details.

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VII. LISTA DOKUMENATALIST OF DOCUMENTS

(Ne originalna dokumenta, samo fotokopije)(No original documents, only photocopies)

(Ukljuiti kopije svih odluka koje se odnose na delove IV i VI.Ukoliko nemate kopije dokumenata, trebalo bi ih nabaviti. Ako ne moete da ih nabaviteobjasnite zato ne moete. Dokumenti koje priloite nee Vam biti vraeni.)

(Include copies of all decisions referred to in Parts IV and VI above. If you do nothave copies, you should obtain them.If you cannot obtain them, explain why not.No documents will be returned to you.)

21. a) ......................................................................................................................................

b) .....................................................................................................................................

c) .....................................................................................................................................

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VIII. IZJAVA I POTPISDECLARATION AND SIGNATURE

Ovde potvrujem da su, prema mom najboljem znanju i uverenju, svi podaci koje sam izneo/lau ovoj predstavci tane.

I hereby declare that, to the best of my knowledge and belief, the information I have given inthe present application form is correct.

Mesto.....................................................Place

Datum ...................................................Date

......................................................................................

(Potpis podnosioca predstavke ili njegovog zastupnika)(Signature of the applicant or of the representative)

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