09b_ehvdrm_a.pdf

ENG - 2021/1 ILHENGUR OF HUMAN RIGHTS Application Form COUR EUROPÉENNE LES DEDIIS DEL HOME Warning : if your application is incomplete, it will not be accepted (see Rule 47 of the Rules of Court) Please note in parlicular that About this application form Hule 47 52 la , requires that a concise statement of facts , This form is a forma legal document and may affect your rights complaints and inlormation about compliance with the and obligations. Please follow the instructions given in the "Notes admissibility criteria MUST be on the relevant parts of the for filling in the application form " . Make sure you fill in all the application form itself . The completed form should cnable the Court to determine the nature and scope of the application fields applicable to your situation and provide all relevant documents . without recourse to any other submissions Barcode label If you have already received a sheet of barcode labels from the European Court of Human Rights, please place ono barcode label in the box below . 45011/27 46011/20 malson . N.D A. The applicant A.1. Individual This section refers to applicants who are individual persons only, If the applicant is an organisation , please go to section A.2. 1. Surname

Reference number if you already have a reference number from the Court In relation to these complaints, please indicate it in the how below , 4601/21 A.2. Organisation This section should only be filled in where the applicant is a company, NGO, association or other legal entity. In this case, please also fill in section D.i. 10. Nunc

2. First namesi 3. Date of birth 0 4. Place of birth

1 1

e 31 12:1960

11. Identification number if any) Kuk . 12. Dale of registration or incorporation (if any) e.g. 27 09 2012 15112019 1 17 የY 13. Activity Consulting . 14. Registered address

5. Nationality

Aovise

5. Address The NETHERLANDS 7. Telephone (including International dialling code: 15. Telephone including international dialling code) 8. Email (if any) 16. Email 9. Sex

male