T.C.

ANAYASA MAHKEMES

BREYSEL BAVURU FORMU

Anayasa Mahkemesi tznn 59. maddeleri hkmlerine gre hazrlanmtr.

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 BREYSEL BAVURU FORMU

I- KSEL BLGLER
A- GEREK KLER N
BAVURUCUNUN
1- T.C. KMLK NUMARASI :

2- ADI:.............................................. 3 - SOYADI :....................................................

4- CNSYET: ERKEK : KADIN :
5- UYRUU :....................................................
6- MESLE :.................................................... GN AY YIL
7- DOUM YER VE TARH :...........................,
8- YAZIMA ADRES:................................................................................................
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9- TELEFON NUMARASI VE ELEKTRONK POSTA ADRES
a- EV :....................................................
b- :....................................................
c- CEP :....................................................
- ELEKTRONK POSTA ADRES :............................................................
AVUKATININ
1- ADI:.............................................. 2 - SOYADI :....................................................
3- YAZIMA ADRES:................................................................................................
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4- TELEFON NUMARASI VE ELEKTRONK POSTA ADRES
a- EV :....................................................
b- :....................................................
c- CEP :....................................................
- ELEKTRONK POSTA ADRES :............................................................

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 B- TZEL KLER N
BAVURUCUNUN
1- UNVANI : ............................................................................................................
2- ADRES :..............................................................................................................
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TEMSLE YETKL KNN
1- T.C. KMLK NUMARASI:

2- ADI:.............................................. 3 - SOYADI :....................................................

4- UYRUU :....................................................
5- MESLE :.................................................... GN AY YIL
6- DOUM YER VE TARH :...........................,
7- YAZIMA ADRES:................................................................................................
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8- TELEFON NUMARASI VE ELEKTRONK POSTA ADRES
a- EV :....................................................
b- :....................................................
c- CEP :....................................................
- ELEKTRONK POSTA ADRES :............................................................
AVUKATININ
1- ADI:.............................................. 2 - SOYADI :....................................................
3- YAZIMA ADRES:................................................................................................
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4- TELEFON NUMARASI VE ELEKTRONK POSTA ADRES
a- EV :....................................................
b- :....................................................
c- CEP :....................................................
- ELEKTRONK POSTA ADRES :............................................................

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 II- AIKLAMALAR

A- Kamu gcnn ilem, eylem ya da ihmaline dair olaylarn tarih srasna gre zeti:

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B- Bireysel bavuru kapsamndaki haklardan hangisinin hangi nedenlerle ihlal
edildii ve buna ilikin gerekeler ve delillere ait zl aklamalar:
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 C- Bavurucunun gncel ve kiisel bir temel hakknn dorudan zedelendii iddiasnn
aklanmas:
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III- BAVURU YOLLARININ TKETLDNE LKN BLGLER

A- Bavuru yollarnn tketilmesine ilikin aamalar:

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B- Bavuru yollarnn tketildii veya bavuru yolu ngrlmemise ihlalin

renildii tarih:

1- KARARI VEREN MAHKEME/MERC/ MAKAM :...............................................

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2- KARARIN TARH VE SAYISI:..................................................................................

3- TEBL VEYA RENME TARH :........................................................................

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C- Bavuru mazeret nedeniyle sresi iinde yaplamamsa buna dair aklamalar:

1- MAZERET NEDEN :............................................................................................

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2- MAZERETN BALANGI VE BT TARH

a- BALANGI TARH :

b- BT TARH :

3- MAZERETE LKN BELGELER : .................................................................

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IV- DER BLGLER

A- Bavurucunun Anayasa Mahkemesi nnde devam eden bir baka bavurusu varsa
numaras: .............................................................................................................................
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B- Bavurucunun kamuya ak belgelerde kimliinin gizli tutulmas talebi ve bunun
gerekesi:
1-TALEB YOK :
2-TALEB VAR :
GEREKES : ...............................................................................................
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 V- SONU TALEPLER
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Bu bavuru formunda vermi olduum bilgilerin doru olduunu; formda

belirtilen bilgilerde, adreslerimde veya bavuruyla ilgili koullarda herhangi bir
deiiklik meydana geldiinde Mahkemeye bildireceimi beyan ederim.

Bavurucu : ................................................. Temsilcisi/Avukat :..........................................

Tarih :

mza :

EKLER
1- Yetki belgesi veya vekletname
2- Bavuru harcnn dendiine dair belge
3- Nfus czdan rnei, bavurucu yabanc ise geerli kimlik belgesi
4- Tzel kiilerde tzel kiilii temsile yetki belgesi
5- Kesin karar ya da ilemin tebli belgesi
6- Dayanlan belgelerin asllar ya da onayl rnekleri
7- Tazminat talebi varsa uranlan zarar ve miktar ile buna ilikin belgeler
8- Bavuru sresinde yaplamamsa mazereti ispatlayan belgeler
Bavurucu ihlal iddiasna dayanak gsterilen belgelere eriememise bunun nedenleri ve gerekeleri