IN THE COURT OF DEEKSHA MADAAN LD.

MM MAHILA
COURT (SOUTH) SAKET COURTS, NEW DELHI

CT CASE NO. 569/2021

IN THE MATTER OF: -

MONICA ….....complainant

VERSUS

PANKAJ &ORS. ..…..Respondents

AFFIDAVIT OF ASSETS AND INCOME AND EXPENDITURE

AS PER ORDER PASSED BY THE HON’BLE COURT IN FAO
NO.369 DATED 6.08.2022- “KUSUM SHARMA VS MAHINDER KUMAR
SHARMA” FILED ON BEHALF OF THE COMPLAINANT

I, MONICA, do hereby solemnly affirm and declare as under: -

That the deponent is the complainant in the above noted matter and is
well conversant with the facts and circumstances of the case and to file
the present affidavit

A. PERSONAL INFORMATION

1. Name MONICA

2. Age/Sex 32

3. Qualification (Educational and ---

Professional)
 Complainant is staying in her
4. Whether the applicant is staying in the
matrimonial house/ parental Matrimonial house with current address
home/separate residence. Please
provide the current residential address i.eR/o H.No B-3/23Phase-4, Gali No.4
of matrimonial home or place of
residence and details of ownership of Aaya Nagar,South Delhi- 110047
residence, if owned by the other family
member

5. Date of Marriage 24.02.2011

6. Date of Separation 29.06.2021

7. General monthly expenses of the NIL

applicant (rent, household expenses,
medical bills, transportation etc.)

B. DETAILS OF LEGAL PROCEEDINGS AND MAINTENANCE BEING PAID

1. Particulars of any ongoing or part legal

proceedings with respect to
maintenance or child support between
the applicant and non- applicant

2. Whether any maintenance has been NO

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, NIL

alongwith a copy of the order/s passed.

4. Whether the order of maintenance NIL

passed in earlier proceedings has been
complied with. If not, arrears of
maintenance.

5. Whether any voluntarily contribution NO

towards maintenance has been
 made/will be made in the future? If yes,
provide details of the same.

C. DETAILS OF DEPENDENT FAMILY MEMBERS

1. Details of dependent family members,

if any.

a. Relationship with dependents

b. Age and sex of dependant/s

2. Disclose if any independent source/s of

income of dependents, 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.

D. MEDICAL DETAILS IF ANY, OF THE DEPONENT AND/OR DEPENDENT

FAMILY MEMBERS.

1. Whether either party or child/ children NO

is suffering from any physical/mental 
disability, or any other serious ailment.
If yes, produce medical records.

2. Whether any dependant family member NO

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 NO

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 2

marriage/marital relationship/ previous 
marriage 

2. Name and age of children  1. HEMANT KUMAR-8 YEARS

2. TANYA KUMARI- 6 YEARS

3. Details of the parent who has the PANKAJ (Father)

custody of the children.  

4. Expenditure for maintenance of NIL

dependant children. 

a. Towards food, clothing and medical NIL

expenses 

b. Towards expenses for education, and NIL

a summary of general expenses

c. Towards expenses, if any, of any NIL

extra educational, vocational or
professional/educational course,
specialized training or special skills
programme of dependent children.  

d. Details of any loan, mortgage, charge NIL

incurred or installment plan (being paid
or payable), if any, on account of any
educational expenses of children. 

5. Whether any voluntary contribution by NO

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 NIL
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  NIL

3. Monthly income  NIL

4. If engaged in Government Service, NIL

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 NIL

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 NIL

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 NO

yes, submit copies of the Income Tax
Returns for the periods given below : 

(i) One year prior to marriage  NIL

(ii) One year prior to separation  NIL

(iii) At the time when the Application NIL

 for maintenance is filed 

8. Income from other sources, such as NIL

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 NIL

accounts for the last 3 years. 

G.ASSETS (MOVABLE AND IMMOVABLE) OWNED BY THE DEPONENT 

1. Self-acquired property, if any:  NIL

2. Properties jointly owned by the parties NIL

after marriage: 

3. Share in any ancestral property:  NIL

4. Other joint properties of the parties NIL

(accounts/ investments/ FDR/ mutual
funds,  stocks, debentures etc.), their
value and status of possession: 

5. Status of possession of immovable NIL

property and details of rent, if leased:

6. Details of loans taken or given by the NIL

Deponent 

7. Brief description of jewellery and ---

ornaments of parties acquired
during/after  marriage 

8. Details of transfer deeds or transactions NIL

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 75,000/-

outstanding against the Deponent, if
any. 

2. Details of any EMIs being paid.  NIL

3. Date and purpose of taking loan or Various essential items on credit such
incurring any such liability:  as milk, vegetables etc. from the
vendors.

4. Actual amount borrowed, if any, and NIL

the amount paid upto date of filing the 
Affidavit: 

5. Any other information which would be NIL

relevant to describe current liabilities of
the  Deponent. 

I. SELF-EMPLOYED PERSONS/PROFESSIONALS/BUSINESS PERSONS/

ENTREPRENEUR 

1. Brief description of nature of NIL

business/profession/vocation/self-
employed/work  activity. 

2. Whether the business/ profession/self- NIL

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/ NIL

profession/ partnership/ self-
employment.
4. Business/partnership/self-employment NIL
liabilities, if any, in case of such
activity.

5. In case of business of company, provide NIL

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 NIL

details of the filings of the last Income
Tax  Return of partnership. 

7. In case of self-employed individual, NIL

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 YES,Accountant in M/s Tech Boulevard at

particulars of the occupation and Noida with income90,000/- per month.
income of  the spouse

3. If not, whether he/she is staying in Some other accomodation

his/her own accommodation, or in a
rented  accommodation or in
accommodation provided by
employer/business/partnership?

4. Particulars of assets and liabilities of NIL

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 INDIAN
current place of residence, if the
Applicant or other spouse is residing
abroad outside India, temporarily or
permanently. 

2. Details of current employment and NIL

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 NIL

expenditure of such applicant/ spouse in
foreign  jurisdiction.  

4. Details of tax liability of applicant/ NIL

other spouse in foreign jurisdiction. 

5. Details of income of applicant/ other NIL

spouse from other sources in
India/foreign  jurisdiction.  

6. Details of expenses incurred or NIL

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 NIL

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 _____2022 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 
 
 DETAILS FOR AFFIDAVIT FOR AGRARIAN DEPONENTS
(KRISHI)

I,MONICA, do hereby solemnly affirm and declare as under: -

That I’m well conversant with the facts and circumstances of the case
and as such I am competent to depose in this affidavit.

1. Total extent of the rural land/s owned, or

the specific share holding in the same 
land

2. Jamabandis/Mutations to show
ownership 

3. Location of the land owned by the party  NIL

4. Nature of land: Whether wet land or dry NIL

land 

5. Whether such land is agricultural land or NIL

non-agricultural land

6. Nature of agriculture/ horticulture  NIL

7. Nature of crops cultivated during the year NIL

: 

8. 8. If rural land is not cultivable, whether NIL

the same is being used for business,
leasing  or other activity : 

9. Income generated during the past 3 years NIL

from the land. 

10. Whether any land is taken on lease/battai NIL

(or any other term used for a lease in the 
local area of the concerned jurisdiction
where rural /agricultural land is located.)

11. (a) Whether owner of any livestock, such NIL

as buffaloes, cows, goats, cattle, poultry, 
 fishery, bee keeping, piggery etc., the
number thereof and Income generated 
therefrom? 

(b) Whether engaged in dairy farming, NIL

poultry, fish farming or any other
livestock  activity. 

12. Loans, if any obtained against the land. NIL

Furnish details of such loans.

13. Any other sources of income : 

14. Liabilities, if any  NIL

15. Any other relevant information:  NIL

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 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 _____2022 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. I further verify that the copies of the
documents filed along  with the affidavit are the copies of the originals. 

DEPONENT