IN THE COURT OF …………………………… METROPOLITAN MAGISTRATE MAHILA

COURT, DISTRICT WEST, TIS HAZARI COURT, DELHI

MC NO. …… OF 2022

IN THE MATTER OF:-

……..COMPLAINANT

VERSUS

……RESPONDENTS

AFFIDAVIT

I……….., son of ……………, aged about ….. years, resident of …………………… do hereby
solemnly declare and affirm as under:

1. That I am the Respondent no. 1 in the above noted case and well conversant with the facts and
circumstances of this case.
2. That in compliance with the direction issued by Hon’ble Supreme Court of India in. Criminal
Appeal No. 730 of 2020, titled as “Rajnesh vs Neha & Ors” the present Affidavit is being filed.

Affidavit of Assets and Liabilities for Non-Agrarian Deponents

I , d/o or s/o , aged about years, resident of

, do hereby solemnly affirm and declare as under:

S.No DESCRIPTION PARTICULARS

.
A Personal Information
1. Name:
2. Age/Sex:
3. Qualifications (Educational and Professional):
4. Whether the Applicant is staying in the
matrimonial house / parental home / separate
 residence. Please provide the current residential
address of matrimonial home or place of
residence and details of ownership of residence, if
owned by other family member.
5. Date of marriage:
6. Date of separation:
7. General monthly expenses of the Applicant (rent,
household expenses, medical bills, transportation,
etc.):

B. Details of Legal Proceedings and Maintenance

being paid
1. Particulars of any ongoing or past legal
proceedings with respect to maintenance or child
support between the Applicant and Non-
Applicant.
2. Whether any maintenance has been awarded in
any proceeding arising under the D.V.Act,
Cr.P.C., HMA, HAMA, etc.? If yes, provide
details of the quantum of maintenance awarded in
the proceedings.
3. If so, provide particulars thereof, alongwith a copy of
the Order/s passed.
4. Whether the Order of maintenance passed in
earlier proceedings has been complied with. If
not, arrears of maintenance.

5. Whether any voluntary contribution towards

maintenance has been made/ will be made in the
future? If yes, provide details of the same
C. Details of Dependant Family Members
1. Details of Dependant family members, if any.
a. Relationship with dependants:
b. Age and sex of dependant/s:
2. Disclose if any independent source/s of income
of the dependants, including interest income,
assets, pension, tax liability on any such income
 and any other relevant details.
3. The approximate expenses incurred on account of the
dependant.

Medical details if any, of the Deponent and/or

D. dependant family members

1. Whether either party or child /children is

suffering from any physical / mental disability, or
any other serious ailment. If yes, produce medical
records.
2. Whether any dependant family member has
serious disability, requiring continuous medical
expenditure. If yes, produce disability certificate
and approximate medical expenditure incurred on
such medical treatment.
3. Whether either party or child/children or any
other dependent family member is suffering from
life-threatening diseases, which would entail
expensive and regular medical expenditure? If
yes, provide details of the same along with
summary of previous details of
hospitalization/medical expenses incurred.

E. Details of Children of the parties

1. Number of children from the existing marriage /
marital relationship/ previous marriage
2. Name and age of children
3. Details of the parent who has the custody of the
children.
4. Expenditure for maintenance of Dependant children.
a. Towards food, clothing and medical expenses
b. Towards expenses for education, and a summary of
general expenses
c. Towards expenses, if any, of any extra
educational, vocational or professional /
educational course, specialised training or
 special skills programme of dependent
children.
d. Details of any loan, mortgage, charge incurred
or installment plan (being paid or payable), if
any, on account of any educational expenses
of children.
5. Whether any voluntary contribution by either of
the parties is being made towards these
educational expenses. If yes, provide details of
the same. Also provide an estimate of any
additional contribution that may be required.
6. Whether any financial support is being provided
by a third party for the educational expenses of
the children?

F. Details of Income of the Deponent

1. Name of employer:
2. Designation:
3. Monthly income:
4. If engaged in Government Service, furnish latest
Salary Certificates or current Pay Slips or proof
of deposit in bank account, if being remitted
directly by employer.
5. If engaged in the private sector, furnish a
certificate provided by the employer stating the
designation and gross monthly income of such
person, and Form 16 for the relevant period of
current employment.
6. If any perquisites, benefits, house rent allowance,
travel allowance, dearness allowance or any other
service benefit is being provided by the employer
during the course of current employment.
7. Whether assessed to income tax?
If yes, submit copies of the Income Tax Returns for
the periods given below :
 (i) One year prior to marriage
(ii) One year prior to separation
(iii) At the time when the Application for
maintenance is filed
8. Income from other sources, such as rent, interest,
shares, dividends, capital gains, FDRs, Post
office deposits, mutual funds, stocks, debentures,
agriculture, or business, if any, alongwith TDS in
respect of any such income.
9. Furnish copies of Bank Statement of all accounts for
the last 3 years.
G. Assets (movable and immovable) owned by the
Deponent
1. Self-acquired property, if any:
2. Properties jointly owned by the parties after marriage:
3. Share in any ancestral property:
4. Other joint properties of the parties (accounts/
investments/ FDR/ mutual funds, stocks,
debentures etc.), their value and status of
possession:
5. Status of possession of immovable property and details
of rent, if leased:
6. Details of loans taken or given by the Deponent
7. Brief description of jewellery and ornaments
of parties acquired during /after marriage
8. Details of transfer deeds or transactions of
alienation of properties previously owned by the
applicant, executed during the subsistence of the
marriage. Also provide brief reasons for such sale
or transaction, if any.

H. Details of Liabilities of the Deponent

1. Loans, liabilities, mortgage, or charge outstanding
against the Deponent, if any.
2. Details of any EMIs being paid.
 3. Date and purpose of taking loan or incurring any such
liability:
4. Actual amount borrowed, if any, and the amount
paid up to date of filing the Affidavit:
5. Any other information which would be relevant
to describe current liabilities of the Deponent

I. Self-employed persons / Professionals / Business

Persons / Entrepreneur
1. Brief description of nature of
business/profession/vocation/self-employed/work
activity.
2. Whether the business/profession/ self-
employment is carried on as an individual, sole
proprietorship concern, partnership concern, LLP,
company or association of persons, HUF, joint
family business or any other form? Give
particulars of Applicant’s share in the
partnership/business/ professional
association/self- employment. In case of
partnership, specify the share in the profit/losses
of the partnership.
3. Net Income from the business/profession/
partnership/self-employment.
4. Business/partnership/self-employment liabilities, if
any, in case of such activity.
5. In case of business of company, provide brief
details of last audited balance sheet to indicate
profit and loss of the company in which such
party is in business in the company.
6. In case of a partnership firm, provide details of
the filings of the last Income Tax Return of
partnership.
7. In case of self-employed individual, provide the
filings of the last Income Tax Return from any
 such professional/business/vocational activity.

J. Information provided by the Deponent with

respect to the income, assets and liabilities
of the other Spouse
1. Educational and professional qualifications of the other
spouse:
2. Whether spouse is earning? If so, give particulars
of the occupation and income of the spouse.
3. If not, whether he/she is staying in his/her own
accommodation, or in a rented accommodation
or in accommodation provided by
employer/business/partnership?
4. Particulars of assets and liabilities of spouse as
known to the deponent, alongwith any supporting
documents.

K. Details of Applicant or the other Spouse, in

case parties are Non-Resident Indians,
Overseas Citizens of India, Foreign Nationals
or Persons living abroad outside India.
1. Details of Citizenship, Nationality and current
place of residence, if the Applicant or other
spouse is residing abroad outside India,
temporarily or permanently.
2. Details of current employment and latest income
in foreign currency of such applicant/spouse, duly
supported by relevant documentation of
employment and income from such foreign
employer or overseas institution by way of
employment letter or testimonial from foreign
employer or overseas institution or latest relevant
bank statement.
3. Details of household and other expenditure of
such applicant/spouse in foreign jurisdiction.
 4. Details of tax liability of applicant/other spouse in
foreign jurisdiction.
5. Details of income of applicant/other spouse from
other sources in India/foreign jurisdiction.
6. Details of expenses incurred or contribution made
on account of spousal maintenance, child support
or any other educational expenses, medical
treatment of spouse or children.
7. Any other relevant detail of expenses or
liabilities, not covered under any of the above
headings and any other liabilities to any other
dependant family members in India or abroad.

Declaration

1. I Declare that I have made a full and accurate disclosure of my income,

expenditure, assets and liabilities from all sources. I further declare that I have
no assets, income, expenditure and liabilities other than as stated in this
affidavit.
2. I Undertake to inform this Court immediately with respect to any material
change in my employment, assets, income, expenses or any other information
included in this affidavit.
3. I understand that any false statement in this affidavit, apart from being contempt
of Court, may also 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, 1860.

DEPONENT

Verification

Verified at on this day of that the contents of the above affidavit

are true to my personal knowledge, no part of it is false and nothing material
has been concealed therefrom, 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 on the basis of record. I further verify that the
copies of the documents filed along with the affidavit are the copies of the
originals.

DEPONENT