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IN THE COURT OF........................ , ...................... COURT, ...................... DV NO. ....... OF 20..
IN THE MATTER OF:
ABC ...COMPLAINANT Versus
XYZ ...RESPONDENTS AFFIDAVIT
I, ………. , wife of ………….., daughter of …………., aged about …… years, resident of ……………………………., do hereby solemnly affirm and declare as under :-
PART - I
PERSONAL INFORMATION RELATING TO THE DEPONENT
S. No. | Description | Particulars |
1. | Name | ............... |
2. | Age | ........ years |
3. | Residential Address | ..................................................... ..................................................... |
4. | E-mail Address | ......................... |
5. | Date of marriage | ......20.. |
6. | Date of separation | ......20.. |
7. | Educational qualifications | .................... |
8. | Professional qualifications | ................. |
9. | Occupation | . |
10. | Monthly income (as mentioned at serial no.45) | .................. |
11. | Monthly expenditure (as mentioned at serial no.60) | ................... |
12. | Whether you are assessed to Income Tax? | Yes/No |
13. | Whether you have sufficient income to support yourself? | Yes/No |
14. | If not, whether you have claimed maintenance from your spouse? | Yes/No |
15. | Whether you are staying at matrimonial home? | Yes/No |
16. | If not staying at matrimonial home, relationship and income of the person with whom you are staying. | ......................................................... ......................................................... ...................... |
17. | Members of the family: (a) Dependent (b) Non-dependent | .................................... |
18. | Whether your spouse has claimed maintenance from you? If so, how much? | N.A. |
19. | Whether you have voluntarily paid or willing to pay maintenance to your spouse? If so, how much? | N.A. |
20. | Whether you are willing to pay litigation expenses to your spouse? If so, how much? | Yes/No |
21. | Particulars of pending litigation between the parties | (i) ................................................... (ii)................................................... (iii) ........................................... |
22. | Whether any maintenance order has been passed by any Court? If so, give particulars and attach copy of the order? | Yes/No |
23. | Whether the maintenance is being paid in terms of the aforesaid order? If so, file the statement of maintenance paid upto date | Yes/No |
24. | Expenses incurred on this litigation | Approx. Rs. ........................... |
25. | Particulars of the bank account with name and address of the bank for the purpose of payment from or receipt of maintenance, as the case may be. | |
26. | Name of your counsel and his/her ................................. |
mobile number and e-mail address | ..................................... Email: .............................. Ph. .............................. |
PART - II
RELEVANT INFORMATION RELATING TO THE SPOUSE
S. No. | Description | Particulars |
27. | Educational and professional qualifications of your spouse | |
28. | Whether your spouse was/is earning? If so, give particulars of the occupation and income of your spouse. | Yes/No |
29. | Whether your spouse is staying at matrimonial home. If not, whether he/she is staying at his/her own accommodation or at a rented accommodation? If staying at a rented accommodation, what is the rent being paid by him/her? | Yes/No |
30. | Particulars of the assets and liabilities of your spouse | Yes/No |
31. | Do you have any documents relating to the income, assets and expenditure of your spouse? If so, give the particulars and attach copies thereof? | Yes/No |
PART – III
RELEVANT INFORMATION RELATING TO THE CHILDREN
S. No. | Description | Particulars |
32. | Children from the marriage with their name and age | Yes/No |
33. | Who has the custody of the minor children | |
34. | Name and address of school(s) where the children are studying | |
35. | Who is bearing the expenditure of Children’s education |
36. | How much expenditure has been incurred on the children’s maintenance and children’s education from the date of separation till now? | |
37. | If the children are in custody of your spouse, whether you have voluntarily paid or willing to pay the expenses for the children’s maintenance and education? If so, how much? | |
38. | Details of expenditure on children Amount | |
(i) School/College fees | ||
(ii) Crech/Day Care/After school care | ||
(iii) Books/Stationery | ||
(iv) Private Tuitions | ||
(v) Pocket Money/Allowances | ||
(vi) Sports | ||
(vii)Outings/summer camps/vacations | ||
(viii) Entertainment | ||
(ix) Others | ||
39. | TOTAL EXPENDITURE (Give monthly expenditure) |
PART-IV
STATEMENT OF INCOME
S. No. | Description | Particulars |
40. In case of salaried persons: | ||
Designation | ||
Name and address of the employer | ||
Date of employment | ||
Gross Income including the salary, D.A., commissions/incentives, bonus, perks etc. | ||
Perquisites and other benefits provided by the employer including accommodation, cars/other automotive, sweeper, gardener, watchman or personal attendant, gas, electricity, water, interest free or concessional loans, holiday expenses, free or concessional travel, free |
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