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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
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(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
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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
32. Children from the marriage with their name and age

33. Who has the custody of the minor children

34. Name and address of school(s) where the children
are studying
35.
education
36. How much expenditure has been incurred on the

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 ch maintenance and
education? If so, how much?
38. Details of expenditure on children Amount (in Rs.)
(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)
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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
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(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) -
(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
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(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
TOTAL INCOME
45.
(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 (i) Groceries/Food items/
expenditure 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.
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(viii) Telephone
(ix) Domestic full
time/part time
helper(s)
(x) Others (specify)
48. Maintenance of (i) Parents
Dependents
(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
(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
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and recreation (ii) Health Club

(iii) Gym
53. Holiday and vacations
54. Gifts
55. Legal/litigation expenses
56. Discharge of (i) Credit card(s) payment
Liabilities
(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)
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PART - VI
STATEMENT OF ASSETS
S. No. Assets List of Assets
At the time of At the time of Present Present
marriage Separation 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.
63. Liquid Assets: Account Number Name of Bank Current
Balance
(i) Details of all bank (i)
accounts including
Current, Savings (ii)
and Demat
Accounts in your (iii)
name, or joint
name and balance
(iv)
in the said account

(ii) Cash in Hand

64. Investments Particulars Current Value
(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
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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
65. Pensions and Retirement Savings Particulars Maturity amount
Plan
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 Present Estimated
market value
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
70. Others Particulars Estimated current
value
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.

PART - VII
STATEMENT OF LIABILITIES
S. No. Description Particulars of Current Value
Debts
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
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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
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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

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
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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

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

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
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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

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

12. Other relevant documents relating to

Income/Assets

13. Other relevant documents relating to

liabilities
PART C
DOCUMENTS RELATING TO EXPENDITURE
(i) Documents relating to the
14.
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)
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
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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
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