Anayasa Mahkemesi Bireysel Basvuru

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T.C.

ANAYASA MAHKEMESİ

BİREYSEL BAŞVURU FORMU


Anayasa Mahkemesi İçtüzüğü’nün 59. maddeleri hükümlerine göre hazırlanmıştır.


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
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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



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Programı olan “Yüksek Yargı Kurumlarının Avrupa Standartları Bakımından Rollerinin Güçlendirilmesi Projesi” kapsamında basılmıştır.

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