Vennligst vær oppmerksom på at klageskjemaet bare vil fungere ved hjelp av Adobe Reader 9 eller nyere versjoner (kan lastes ned fra www.adobe.com). Vennligst lagre en kopi av klageskjemaet før du fyller det ut med Adobe Reader. Skriv deretter ut hele klageskjemaet og send det med post til Domstolen. NOR - 2014/1 Klageskjema Om dette klageskjema Dette klageskjemaet er et formelt juridisk dokument som kan påvirke dine rettigheter og plikter. Vennligst følg de forklaringer som gis i Veiledning for utfylling av klageskjemaet. Husk å fylle ut alle felter som er relevante for din situasjon og fremlegge alle relevante dokumenter. Strekkode-etikett Advarsel: Hvis din klage er ufullstendig, vil den ikke bli behandlet (se Regel 47 i Domstolens regelverk). Merk særlig at Regel 47 § 2 (a) fastslår at: "Alle de opplysninger som det henvises til i paragraf 1 (d) til (f) [redegjørelse for sakens omstendigheter, påståtte krenkelser og opplysninger om oppfyllelse av vilkårene for realitetsbehandling], må redegjøres for i dette avsnittet slik at Domstolen kan klarlegge innholdet og rekkevidden av klagen uten å se hen til annet materiale.» Saksnummer Hvis du allerede har mottatt et sett etiketter med strekkode fra Den europeiske menneskerettighetsdomstol, vennligst fest en av etikettene i feltet nedenfor. Hvis du allerede har mottatt et referansenummer fra Domstolen i forbindelse med disse klager, angi det vennligst i feltet nedenfor. A. Klageren (privatperson) B. Klageren (organisasjon) Dette avsnitt vedrører bare klagere som er privatpersoner. Hvis klageren er en organisasjon, vennligst gå til Avsnitt B. Dette avsnitt skal bare utfylles, hvis klageren er et selskap, en ikkestatlig organisasjon, en forening eller en annen juridisk enhet. 1. Etternavn 9. Navn 2. Fornavn 10. Eventuelt identifiseringsnummer. 3. Fødselsdato f.eks. 27/09/2012 D D M M Å Å 4. Statsborgerskap Å 11. Registrerings- eller grunnleggelse dato (hvis den finnes) Å f.eks. 27/09/2012 D D M M Å Å 12. Virksomhet 5. Adresse 13. Registreringsadresse 6. Telefon (med landkode) 7. Eventuell e-post 14. Telefon (med landkode) 8. Kjønn mann kvinne 15. E-post Å Å Den europeiske menneskerettighetsdomstol - Klageskjema 2/11 C. Klagerens representant(er) Hvis klageren ikke er representert, gå til Avsnitt D. Ikke advokat/offisiell organisasjon Advokat Vennligst fyll ut denne delen av skjemaet, hvis du representerer en klager, men ikke er advokat. Vennligst fyll ut denne delen av skjemaet, hvis du representerer klageren som advokat. Forklar i feltet nedenfor i hvilken egenskap du representerer klageren eller angi ditt forhold til klageren eller din offisielle funksjon hvis du representerer en organisasjon. 24. Etternavn 16. Egenskap / forhold / funksjon 25. Fornavn 17. Etternavn 26. Statsborgerskap 18. Fornavn 27. Adresse 19. Statsborgerskap 20. Adresse 28. Telefon (med landkode) 29. Fax 21. Telefon (med landkode) 30. E-postadresse 22. Fax 23. E-postadresse Fullmakt Klageren må gi myndighet til hver representant til å handle på hans eller hennes vegne ved å underskrive fullmakten nedenfor (se Veiledning for utfylling av klageskjemaet). Jeg gir herved den nevnte personen fullmakt til å representere meg under saksbehandlingen for Den europeiske menneskerettighetsdomstol om den klagen jeg har bragt inn i henhold til artikkel 34 i konvensjonen. 31. Klagers underskrift 32. Dato f.eks. 27/09/2012 D D M M Å Å Å Å Den europeiske menneskerettighetsdomstol - Klageskjema 3/11 D. Stat(er) klagen er rettet mot 33. Sett kryss ved navnet på den eller de stater, klagen er rettet mot ALB - Albania ITA - Italia AND - Andorra LIE - Liechtenstein ARM - Armenia LTU - Litauen AUT - Østerrike LUX - Luxembourg AZE - Aserbajdsjan LVA - Latvia BEL - Belgia MCO - Monaco BGR - Bulgaria MDA - Moldova BIH - Bosnia-Hercegovina MKD - “Den tidligere jugoslaviske republikk Makedonia” CHE - Sveits MLT - Malta CYP - Kypros MNE - Montenegro CZE - Tsjekkia NLD - Nederland DEU - Tyskland NOR - Norge DNK - Danmark POL - Polen ESP - Spania PRT - Portugal EST - Estland ROU - Romania FIN - Finland RUS - Russland FRA - Frankrike SMR - San Marino GBR - Storbritannia SRB - Serbia GEO - Georgia SVK - Slovakia GRC - Hellas SVN - Slovenia HRV - Kroatia SWE - Sverige HUN - Ungarn TUR - Tyrkia IRL - Irland UKR - Ukrainia ISL - Island Den europeiske menneskerettighetsdomstol - Klageskjema 4/11 Klagens innhold All informasjon om sakens faktiske omstendigheter, om klageren og om oppfyllelse av kravene om uttømmelse av interne rettsmidler og av seksmånedersfristen beskrevet i Artikkel 35 § 1 i konvensjonen må redegjøres for i denne del av klageskjemaet (avsnitt E., F. og G.) (Regel 47 § 2 (a)). Klageren kan tilføye detaljerte anførsler i klageskjemaet. Den slags supplerende innlegg må ikke overskride 20 sider (Regel 47 § 2 (b)); denne begrensningen av antall sider omfatter ikke kopier av vedlegg og avgjørelser. E. Redegjørelse for sakens faktiske omstendigheter 34. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Når du fyller inn denne delen, bes du sørge for at opplysningene ikke overskrider feltets størrelse. Ønsker du å sende inn supplerende opplysninger, vennligst følg instruksjonene i «Veiledning for å fylle ut klageskjemaet». Den europeiske menneskerettighetsdomstol - Klageskjema 5/11 Redegjørelse for sakens faktiske omstendigheter (fortsettelse) 35. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Når du fyller inn denne delen, bes du sørge for at opplysningene ikke overskrider feltets størrelse. Ønsker du å sende inn supplerende opplysninger, vennligst følg instruksjonene i «Veiledning for å fylle ut klageskjemaet». Den europeiske menneskerettighetsdomstol - Klageskjema 6/11 Redegjørelse for sakens faktiske omstendigheter (fortsettelse) 36. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Når du fyller inn denne delen, bes du sørge for at opplysningene ikke overskrider feltets størrelse. Ønsker du å sende inn supplerende opplysninger, vennligst følg instruksjonene i «Veiledning for å fylle ut klageskjemaet». Den europeiske menneskerettighetsdomstol - Klageskjema F. 7/11 Angi hvilke krenkelser av konvensjonen og/eller protokollene du påberoper deg, samt anførsler. 37. Påberopt artikkel Forklaring ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ 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_____________________________________________________________________ _____________________________________________________________________ Den europeiske menneskerettighetsdomstol - Klageskjema 8/11 G. Bekreft vennligst for hver klage at du har uttømt tilgjengelige nasjonale rettsmidler, inklusive anker, og angi hvilken dato da den siste og endelige avgjørelsen ble fattet og mottatt, for å vise at du har overholdt seksmånedersfristen. 38. Klage Angi de rettsmidler du har brukt og datoen for den endelige avgjørelsen ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Den europeiske menneskerettighetsdomstol - Klageskjema 39. Foreligger/forelå det noe rettsmiddel som du ikke har benyttet? 9/11 Ja Nei 40. Hvis du svarte ja ovenfor, vennligst opplys om hvilket rettsmiddel du kunne ha benyttet og angi grunnen til at du ikke gjorde det. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ H. Opplysninger om eventuelle annen internasjonal saksbehandling. 41. Har du innbragt noen av disse klagene for et annet internasjonalt tilsynsorgan? Ja Nei 42. Hvis du svarte ja ovenfor, vennligst gi en nøyaktig redegjørelse for behandlingen av saken (innbragte klager, navn på den internasjonale instansen samt dato og innhold av hver avgjørelse som er blitt truffet). ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 43. Har du (som klageren) eller har du hatt andre klager til behandling for Domstolen? Ja Nei 44. Hvis du svarte ja ovenfor, vennligst oppgi klagenummeret i feltet nedenfor. __________________________________________________________________________________________________ __________________________________________________________________________________________________ Den europeiske menneskerettighetsdomstol - Klageskjema 10/11 I. Liste over vedlagte dokumenter Du bør vedlegge fullstendige og leselige kopier av alle dokumenter. Ingen dokumenter vil bli sent tilbake til deg. Det er derfor viktig at du sender inn kopier, ikke originaler. Du MÅ: - sortere dokumentene etter dato og saksbehandling; - nummerere sidene fortløpende; - IKKE stifte, binde eller klistre sammen dokumentene. 45. Vennligst gi en fortegnelse over dokumentene i kronologisk rekkefølge og med en kortfattet beskrivelse i feltet nedenfor. 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. _____________________________________________________________________________________________ Den europeiske menneskerettighetsdomstol - Klageskjema 11/11 Andre bemerkninger Har du andre bemerkninger til din klage? 46. Bemerkninger __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Erklæring og underskrift Jeg erklærer herved at de opplysninger jeg har gitt i dette klageskjema etter min beste overbevisning er korrekte. 47. Dato f.eks. 27/09/2012 D D M M Å Å Å Å Klageren(ne) eller klagers representant(er) skal underskrive i nedenstående felt. 48. Underskrift(er) Klageren(ne) Representant (er) – sett kryss Bekreftelse av korrespondent Hvis det er flere enn én klager eller flere enn én representant, så angi vennligst navn og adresse på den personen som Domstolen skal skrive til. 49. Navn og adresse på Klageren(ne) Representant (er) – sett kryss __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Det utfylte klageskjemaet må underskrives og sendes med post til: The Registrar European Court of Human Rights Council of Europe 67075 STRASBOURG CEDEX FRANCE