ANNEXURE – A1
(FORMAT OF AFFIDAVIT OF ASSETS, INCOME AND EXPENDITURE TO BE FILED BY THE BOTH PARTIES)
AFFIDAVIT
I , son of / wife of _, aged about years, resident of , do hereby solemnly declare and affirm as under:
PART – I
PERSONAL INFORMATION RELATING TO THE DEPONENT
|
S.No. |
Description |
Particulars |
| 1. | Name | |
| 2. | Age | |
| 3. | Residential Address | |
| 4. | E-mail Address | |
| 5. | Date of marriage | |
| 6. | Date of separation | |
| 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? | |
| 13. | Whether you have sufficient income to support
yourself? |
|
| 14. | If not, whether you have claimed maintenance from
your spouse? If so, how much? |
|
| 15. | Whether you are staying at matrimonial home? | |
| 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? | |
| 19. | Whether you have voluntarily paid or willing to pay maintenance to your spouse? If so, how much? | |
| 20. | Whether you are willing to pay litigation expenses to your spouse? If so, how much? | |
| 21. | Particulars of pending litigation between the parties | |
| 22. | Whether any maintenance order has been passed by any Court? If so, give particulars and attach copy of the order? | |
| 23. | Whether the maintenance is being paid in terms of the aforesaid order? If so, file the statement of maintenance paid upto date | |
| 24. | Expenses incurred on this litigation | |
| 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 |
PART – II
RELEVANT INFORMATION RELATING TO THE SPOUSE
| 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. |
|
| 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? |
|
| 30. | Particulars of the assets and liabilities of your |
| spouse | ||
| 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? |
PART – III
|
RELEVANT INFORMATION RELATING TO THE CHILDREN
PART-IV STATEMENT OF INCOME
| S.No | Description | Particulars |
| 40. | In case of salaried persons:
(i) Designation (ii) Name and address of the employer (iii) Date of employment (iv) Gross Income including the salary, D.A., commissions/incentives, bonus, perks etc. (v) 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 (vi) Deductions from the gross income (vii) Income Tax paid (viii) Net income (ix) Value of stock option benefits if provided by the employer (x) Pension and retirement benefits payable at the time of retirement |
|
| 41. | In case of self-employed persons:
(i) Nature of business/profession (ii) 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 (iii) Number of employees |
| (iv) Annual turnover/gross receipts
(v) Gross Profit (vi) Net Income (vii) Income Tax (viii) Details and value of benefits in kind, perks or other remuneration e.g. provision of car, payment of accommodation etc (ix) Amount of regular monthly withdrawal or drawings |
||
| 42. | In case the business/ profession is carried on as a Partnership Firm/Company:
(i) Registered/Corporate Office of the firm/company (ii) Information and particulars with regard to your shareholding, involvement in the affairs and management of the firm/company (iii) Director’s/ Partner’s remuneration :- (a) Salary (b) Interest (c) Rent (d) Commission (e) Others (iv) List of all the bank accounts of the firm/company (v) Location of the statutory records and books of account of the firm/company (vi) List of immovable assets, land and building etc. of the firm/company. (vii) Number of workmen/employees (viii) Current value of your business interest(s) (ix) Current value of your business assets (x) List of directorships held, sitting fees, commission or any other remuneration (xi) 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:
(i) Agricultural Income |
| (ii) Rent
(iii) Interest on bank deposits and FDRs (iv) Interest on investments including deposits, NSC, IVP, KVP, Post Office schemes, PPF, loans etc. (v) Dividends (vi) Mutual Funds (vii) Annuities (viii) Lease of machinery, plant or furniture (ix) Sale of movable/ immovable assets (x) Gifts |
||
| 44. | Any other income not covered above | |
| 45. | TOTAL INCOME
(Give monthly income) |
PART V STATEMENT OF EXPENDITURE
| S. No. | Description | Amount
(in Rs.) |
|
| 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. |
|||
| viii) Telephone | |||
| (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 | (i) Club |
| and recreation | (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) Installment 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
(Not specified above) |
||
| 60. | TOTAL EXPENDITURE
(Give monthly expenditure) |
||
PART – VI STATEMENT OF ASSETS
| S. No. | Assets | List of Assets | |||
| At the time of marriage | At the time of Separation | Present | Present Estimated Market Value | ||
| 61. | Real Estate Including
(i) Land (ii) Built up properties (iii) Lease hold properties (iv) Agricultural land (v) Investment in real estate such as booking of plots, flats and other immovable properties in your name or in joint names. (vi) 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.) |
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| 62. | Joint Properties
(i) Properties presented at or about the time of marriage, which belong jointly to both the husband and wife. Give the status of their possession. (ii) Other joint properties of the parties. Give the status of their possession. (iii) Whether any litigation pending with respect to the joint property? If so, give particulars. |
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| 63. | Liquid Assets:
(i) Details of all bank accounts including Current, Savings and Demat Accounts in your name, or joint name and balance in the said account |
Account Number | Name of Bank | Current Balance | |||||
| (i) | |||||||||
| (ii) | |||||||||
| (iii) | |||||||||
| (iv) | |||||||||
| (ii) Cash in Hand | |||||||||
| 64. | Investments
(i) Details of all investments you hold or, in which you have interest and their current value: a) FDRs, NSC, IVP, KVP, Post Office schemes, PPF etc. b) Deposits with Government and Non-Government entities |
Particulars | Current Value | ||||||
| c) Stocks, shares, debentures, bonds, units and mutual funds, etc.
d) Life and endowment policies and surrender value e) Loan given to friends, relatives and others f) Other investments not covered by above items |
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| 65. | Pensions and Retirement Savings Plan | Particulars | Maturity amount | |
| Indicate name of institution where accounts are held, name and address of pension plan and pension details. | ||||
| 66. | Corporate/Business Interests | Particulars | Current value | |
| List any interest you hold, directly or indirectly, in any corporation, unincorporated business, partnership, trust, joint venture and Association of Persons, Society etc. | ||||
| 67. | Movable Assets | Particulars | Current value | |
| (i) Motor Vehicles (List cars, motorcycles, scooters etc. along with their brand and registration number)
(ii) Livestock (iii) Mobile phone(s) (iv) Computer/Laptop (v) Other electronic gadgets including I-pad etc. (vi) TV, Fridge, Air Conditioner, Microwave, Washing machine, etc. (vii) Other household and kitchen appliances (viii) Quantity of gold, silver and diamond jewellery (ix) Quantity of Silver Utensils |
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| 68. | Intangible properties
Including patents, trademark, copyright design and goodwill and their value |
||
| 69. | About disposal of properties
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 |
Particulars | Present Estimated 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
|
PART – VIII
GENERAL INFORMATION RELATING TO THE STATUS, STANDARD OF LIVING AND LIFESTYLE
| 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. | Description | |
| 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 |
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| 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 and Annexures for last 3 years | |||
| 9. | In case of Salaried Persons
(i) Appointment letter along with salary structure at time of appointment. (ii) Last Salary Slip (iii) Forms 16, 16A, 12BA & 26AS (iv) Cost to Company Certificate and CIBIL Certificate, wherever applicable (v) Copies of TDS certificates |
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| 10. | In case of self-employed persons
(i) Balance Sheet and Profit & Loss Account (ii) Balance Sheet and Profit & Loss Account of the proprietorship firm, if the business is carried on in the name of a sole proprietorship concern (iii) 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 (iv) Balance Sheet and Profit & Loss Account of the Company in which the deponent is a |
| Director
(v) Balance Sheet and Profit & Loss Account of the Association of Persons, HUF, Joint Family business or trust in which the deponent has share (vi) Copy of account of the deponent in the books of the business (vii) Copies of TDS certificates |
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| 11. | In case of Income from other sources:
(i) Lease Deed(s)/Rent Agreement(s) /Licence Agreement(s) in respect of the rental income (ii) Interest Certificate in respect of the interest income on deposits and investments (iii) Dividend Certificates in respect of dividend income (iv) Demat holding Statement (v) Sale Deed(s)/transfer documents in respect of the profit on sale of property/properties |
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| 12. | Other relevant documents relating to Income/Assets | ||||
| 13. | Other relevant documents relating to liabilities | ||||
| PART C
DOCUMENTS RELATING TO EXPENDITURE |
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| 14. | (i) Documents relating to the expenditure on education of children including tuition fees
(ii) Rent and maintenance receipts (iii) Electricity, water, security and |
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| gas bills
(iv) Documents relating to the salary paid to the employees including domestic helper(s) (v) Documents relating to expenditure on conveyance (vi) Debit and Credit Card statements of all cards (vii) Frequent Flier’s Card statements (viii) Mobile and landline phone bills (ix) Internet and TV cable/ Set – Top Box bills (x) Documents relating to the re- payment of the loans (xi) PPF, EPF and other superannuation fund receipts (xii) Receipts of premium of insurance policies (xiii) Receipts of payments in respect of mutual funds (xiv) Documents relating to payment of interest on bank and other loans (xv) Documents relating to the payment of taxes, including Income Tax and Property Tax (xvi) Other relevant documents relating to Expenditure |
Declaration:
- 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
- I undertake to inform this Court immediately upon any material change in my employment, assets, income, expenditure or any other information included in this
- 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 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. I further verify that the copies of the documents filed along with the affidavit are true copies of the originals.
DEPONENT