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 Yes/No

maintenance from your spouse?

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

meals, free education, gifts, vouchers, etc.
credit card expenses, club expenses, use of
movable assets by employees, transfer of
assets to employees, value of any other
benefit/amenity/service/ privilege and the value
of such perquisites and benefits
Deductions from the gross income
Income Tax paid
Net income
Value of stock option benefits if provided by
the employer
Pension and retirement benefits payable at the
time of retirement
41. In case of self-employed persons:
Nature of business/profession
Whether the business/profession is carried on
as an individual, sole proprietorship concern,

partnership concern, company or association of
persons, HUF, joint family business or in any
other form. Give particulars of your share in
the business/ profession. In case of
partnership, specify the share in the
profit/losses of the partnership
Number of employees
Annual turnover/gross receipts
Gross Profit
Net Income
Income Tax
Details and value of benefits in kind, perks or
other remuneration e.g. provision of car,
payment of accommodation etc.
Amount of regular monthly withdrawal or
drawings
42. In case the business/ profession is carried on as
a Partnership Firm/Company :
Registered /Corporate Office of the

firm/company
Information and particulars with regard to your
shareholding, involvement in the affairs and
management of the firm/company
Director’s/ Partner’s remuneration : –
a) Salary
b) Interest
c) Rent
d) Commission
e) Others
List of all the bank accounts of the
firm/company

Location of the statutory records and books of
account of the firm/company
List of immovable assets, land and building
etc. of the firm/company.
Number of workmen/employees
Current value of your business interest(s)
Current value of your business assets
List of directorships held, sitting fees,
commission or any other remuneration
Net worth of the company in which you are
Director along with the number of shares held
in the Company
43. Income from Other Sources :
Agricultural Income
Rent
Interest on bank deposits and FDRs
Interest on investments including deposits,
NSC, IVP, KVP, Post Office schemes, PPF,
loans etc.
Dividends
Mutual Funds
Annuities
Lease of machinery, plant or furniture
Sale of movable/ immovable assets

Gifts
44. Any other income not covered above
45. TOTAL INCOME (Give monthly income)

PART-V

STATEMENT OF EXPENDITURE

S. No. Description Particulars
46. Housing (i) Monthly rent
(ii) Mortgage payment(s)
(iii) Repairs & Maintenance
(iv) Property tax

47. Household
expenditure

(i) Groceries/Food
items/ Personal
care/clothing
(ii) Water
(iii) Electricity
(iv) Gas
(v) Telephone/Mobile
(vi) TV Cable/Set-top
Box charges & Internet
services
(vii) Maintenance,
replacement and repair of
household items,
appliances and
kitchenware.
(ix) Domestic full
time/part time helper(s)
(x) Others (specify)

48. Maintenance
of
Dependents

(i) Parents
(ii)Children (as
mentioned at serial
no.39)
(iii) Others

49. Transport (i) Private Transport
(a) Driver(s)
(b) Fuel
(c) Repair/Maintenance

(d) Insurance

(e) Loan repayment
(ii) Public Transport
(a) Bus
(b) Taxi
(c) Metro
(d) Auto

50. Medical
expenditure

(i) Doctor’s Charges
(ii) Medication
(iii) Hospital
(iv) Other medical
expenditure
(v) Others (specify)

51. Insurance (i) Life
(ii) Annuity
(iii) Householders
(iv) Medi-Claim

52. Entertainment
and recreation

(i) Club
(ii) Health Club
(iii) Gym
53. Holiday and vacations
54. Gifts
55. Legal/litigation expenses
56. Discharge of
Liabilities

(i) Credit card(s) payment
(ii) Hire purchase/lease
(iii) Repayment of Loans
(a) House loan
(b) Car loan
(c) Personal loan

(d) Business loan
(e) Any other loan
(iv) Name of the lenders
(v) Mode of repayment
(vi) Instalment amount
(vii)Other personal
liabilities

57. Miscellaneous (i) Newspapers, magazines,

books
(ii) Religious
contributions/ Charities
(iii) Others (specify)

58. Pocket Money/Allowance
59. Other expenditure (Teacher Training Course)
60. TOTAL EXPENDITURE (Give
monthly expenditure)

PART – VISTATEMENT OF ASSETS

S.
No.

Assets List of Assets

At the
time of
marriage

At the
time of
Separatio
n
Present Present
Estimated
Market
Value

61. Real Estate Including
Land
Built up properties
Lease hold properties
Agricultural land
Investment in real
estate such as
booking of plots,

flats and other
immovable properties
in your name or in
joint names.
Other properties
Note 1. : – List your interest in properties, including lease hold interest and
mortgages, whether or not you are registered as owner.
Note 2. : – Provide legal descriptions and indicate estimated market value of
your interest without deducting encumbrances or costs of disposition. (Record
encumbrances under debts.)
62. Joint Properties N.A.
Properties presented
at or about the time
of marriage, which

belong jointly to both
the husband and wife.
Give the status of
their possession.
Other joint properties
of the parties. Give
the status of their
possession.
Whether any
litigation pending
with respect to the
joint property? If so,
give particulars.
63. Liquid Assets:
(i) Details of all bank
accounts including
Current, Savings
and Demat
Accounts in your

Account
Number

Name of
the Bank

Current
Balance

(i)
(ii)
(iii)

name, or joint
name and balance
in the said
account

(iv)

(ii) Cash in hand
64. Investments: Details
of all investments you
hold or, in which you
have interest and their
current value:

Particulars Current Value

FDRs, NSC, IVP,
KVP, Post Office
schemes, PPF etc.
Deposits with
Government and Non
Government entities

Stocks, shares,
debentures, bonds,
units and mutual
funds, etc.
Life and endowment
policies and surrender
value
Loan given to friends,
relatives and others
Other investments not
covered by above
items
65. Pensions and
Retirement Savings
Plan
Indicate name of

Particulars Maturity Amount

institution where
accounts are held,
name and address of
pension plan and
pension details
66. Corporate/Business
Interests
List any interest you
hold, directly or
indirectly, in any
corporation,
unincorporated
business, partnership,
trust, joint venture
and Association of
Persons, Society etc.

Particulars Current Value

67. Movable Assets Particulars Current Value
Motor Vehicles (List
cars, motorcycles,
scooters etc. along

with their brand and
registration number)
Livestock
Mobile phone(s)
Computer/Laptop
Other electronic
gadgets including I –
pad etc.
TV, Fridge, Air
Conditioner,
Microwave, Washing
machine, etc. (all
with the Respondent
in Delhi/ Dubai)

Other household and
kitchen appliances
Quantity of gold,
platinum, silver and
diamond jewellery

p

All Jewellery in Possession of the Respondent.
Quantity of Silver
Utensils

All Silver utensils in Possession of The Respondent.

68. Intangible properties
Including patents,
trademark, copyright
design and goodwill
and their value

Particulars Present
Estimated
Market Value

N.A.

69. About disposal of
properties

Particulars Present
Estimated

Particulars of
properties (movable
as well as
immovable)
sold/agreed to be sold
between the date of
marriage till the date
of filing of this
affidavit and the sale
consideration
received from the
purchaser

Market Value

70. Others
List anything else of
value that you own,
including precious
metals, collections,
works of art,
jewellery or
household items of
high value. Include
location of safety
deposit lockers.

Particulars Estimated
Current Value

PART – VII

STATEMENT OF LIABILITIES
S. No. Description Particulars
of Debts

Current Value

71. Secured debt(s)
List all mortgages, loans, and

any other debts secured
against an asset
72. Unsecured Debt(s)
List all bank loans, personal
loans, credits, overdrafts,

credit cards and any other
debts
73. Other
List any other debts, including
obligations that are relevant to
a claim

PART – VIII

GENERAL INFORMATION RELATING TO THE STATUS, STANDARD

OF LIVING AND LIFESTYLE

S. No. Description Particulars
74. Particulars of residential
accommodation where your
are presently staying (in sq.
feet)
75. Who is the owner of the residential
accommodation? In case of rented
accommodation, specify the
monthly rent
76. Number of part-time/full time
domestic helpers and their wages
77. Average monthly withdrawal
from bank(s)
78. Mode of travel in city/outside city
79. Membership of clubs/health
clubs/gyms, societies and other
associations. Specify the
membership fee and subscription
80. Particulars of credit/debit card(s),
its limit and usage
81. Particulars of frequent flier cards —
82. Frequency of foreign travel, business

as well as personal
83. Category of hotels ordinarily used
for stay, official as well as personal
84. Category of hospitals opted for
medical treatment including type of
rooms
85. Brand of vehicle, mobile and wrist
watch, pen, sunglasses,
wallet/bags.
86. Expenditure ordinarily incurred on
family functions including birthday
of the children
87. Expenditure ordinarily incurred
on festivals
88. Expenditure incurred on marriage
of family members
89. Status of the deponent and
his/her family: –
∙ High
∙ Upper Middle
∙ Middle
∙ Lower Middle
∙ Low
∙ Below poverty line

PART – IX

DOCUMENTS RELATING TO ASSETS, INCOME AND EXPENDITURE

PART A

DOCUMENTS RELATING TO PERSONAL INFORMATION
S. No. Descriptions
1. Ration Card
2. Voter ID Card

3. Aadhar Card
4. Driving Licence
5. PAN Card
6. Passport

PART B

DOCUMENTS RELATING TO INCOME, ASSETS AND LIABILITIES
S. No. Description Please Tick

Attached Not Applicable To follow

7. Statement of Account
of all bank accounts
including current,
savings and Demat
accounts for last 3
years
8. Income Tax Return(s)
along with Statement
of Income for last 3
years
9. In case of Salaried
Persons
Appointment letter
along with salary
structure at time of
appointment.
Last Salary Slip
Forms 16, 16A , 12BA
& 26AS
Cost to Company
Certificate and
CIBIL Certificate,
wherever

applicable
Copies of TDS certificates
10. In case of self-
employed persons
Balance Sheet and
Profit & Loss Account
Balance Sheet and
Profit & Loss Account
of the proprietorship
firm, if the business is
carried on in the name
of a sole
proprietorship concern
Balance Sheet and
Profit & Loss Account
of the

partnership firm, if the
deponent is a partner in
a firm along with the
Schedule showing the
distribution of partners’
remuneration and share
of profits/losses of the
partnership firm and
the copy of the
partnership deed
Balance Sheet and
Profit & Loss Account
of the Company in
which the deponent is
a Director
Balance Sheet and Profit
& Loss Account of the
Association of Persons,

HUF, Joint Family
business or trust in which
the deponent has share
Copy of account of the
deponent in the books
of the business
Copies of TDS certificates
11. In case of Income from
other sources:
Lease Deed(s)/Rent
Agreement(s) /Licence
Agreement(s) in respect
of the rental income
Interest Certificate in
respect of the interest
income on deposits and
investments
Dividend Certificates in
respect of dividend
income

Demat holding Statement
Sale Deed(s)/transfer
documents in respect of
the profit on sale of
property/properties
12. Other relevant
documents relating to
Income/Assets
13. Other relevant
documents relating to
liabilities

PART C

DOCUMENTS RELATING TO EXPENDITURE
14. Description Please Tick

Attached Not Applicable To Follow

Documents relating to the
expenditure on education
of children including
tuition fees
Rent and maintenance
receipts
Electricity, water,
security and gas bills
Documents relating to the
salary paid to the
employees including
domestic helper(s)
Documents relating to
expenditure on
conveyance
Debit and Credit Card
statements of all cards
Frequent Flier’s Card
statements
Mobile and landline
phone bills
Internet and TV cable/ Set

– Top Box bills
Documents relating to the
re – payment of the loans
PPF, EPF and other
superannuation fund
receipts

Receipts of premium of
insurance policies
Receipts of payments in
respect of mutual funds
Documents relating to
payment of interest on
bank and other loans
Documents relating to the
payment of taxes,
including Income Tax
and Property Tax
Other relevant documents
relating to Expenditure

Declaration:
1. I solemnly declare and affirm that I have made full and accurate voluntary
disclosure of my income, expenditure, assets and liabilities from all sources. I
further declare and affirm that I have no assets, income, expenditure and
liabilities other than set out in this affidavit.
2. I undertake to inform this Court immediately upon any material change in my
employment, assets, income, expenditure or any other information included in
this affidavit.
3. I understand that any false statement made in this affidavit may constitute an
offence under Section 199 read with Sections 191 and 193 of the Indian Penal
Code punishable with imprisonment upto seven years and fine, and Section 209
of Indian Penal Code punishable with imprisonment upto two years and fine. I
have read and understood Sections 191, 193 199 and 209 of the Indian Penal
Code.

DEPONENT

Verification:
Verified at ____________on this ____ day of ___________ that the contents of the
above affidavit relating to my assets, income and expenditure are true to my
knowledge, no part of it is false and nothing material has been concealed there from,
whereas the contents of the above affidavit relating to the assets, income and

expenditure of my spouse are based on information believed to be true. I further
verify that the copies of the documents filed along with the affidavit are true copies
of the originals.

DEPONENT