ANNEXURE-A1

(FORMAT OF AFFIDAVIT OF ASSETS, INCOME AND

EXPENDITURE TO BE FILED BY THE BOTH
PARTIES)
AFFIDAVIT
I Smt. Asha , wife of Babu Lal , aged
about 70 years, resident of 69, Mathura Road,
Hari Nagar ashram, Delhi - 110014 , do hereby
solemnly declare and affirm as under:
PART-1
PERSONAL INFORMATION RELATING TO THE
DEPONENT.
S.N Description Particulars
o.
1. Name Smt. Asha
2. Age 70
3. Residential Address 69, Mathura Road,
Hari Nagar
ashram, Delhi -
110014
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
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 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
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 the statement of
maintenance paid up to
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 Adv. Athar Alam
his/her mobile number and M-
e-mail address 9891356333/444
Email –
athar4333@gmail.
com

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

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 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
32. Children from the marriage Yogesh (40 years
with their name and age old), Deviki (38
years old), Arti
(32 years old),
Bharti (31 years
old), Rajendra
(died on 21st sept
2018), Chandra
Prakash (died on
21st dec 2018)
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

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 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 Amount (in Rs.)
children
i. School/College fees
ii. Creche/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

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 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
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 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. Director's/Partner's
remuneration: -
a. Salary
b. Interest
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 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
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 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 i. Groceries/Food
expenditure items/ Personal
care/clothing
ii. Water
iii. Electricity
iv. Gas
v. Telephone/
Mobile
vi. TV Cable/Set-

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 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. Maintenanc i. Parents
e of ii. Children (as
dependents mentioned at
serial no. 39)
iii. others
49. Transport i. Private
Transport
a. Driver(s)
b. Fuel
c. Repair/
Maintenan
ce
d. Insurance
e. Loan
repayment
ii. Public
Transport
a. Bus
b. Taxi
c. Metro
d. Auto
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 50. Medical i.
Doctor’s
expenditure charges
ii. Medication
iii. Hospital
iv. Other medical
expenditure
v. Others (specify)
51. Insurance i. Life
ii. Annuity
iii. Householders
iv. Medi-claim
52. Entertainm i. Club
ent and ii. Health club
recreation iii. gym
53. Holiday and vacations

54. Gifts

55. Legal/litigation expenses

56. Discharge i. Credit card(s)

of Liabilities 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
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 repayment
vi. Instalment
amount
vii. Other personal
liabilities
57. Miscellaneo i. Newspapers,
us 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
SATATEMENT OF ASSETS
S. Assets List of Assets
No. At the At Prese Present
time of the nt Estimat
marria time ed
ge of Market
Sepa Value
ratio
n
61. i. Land
ii. Built
propertie
s up
iii. Lease

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 propertie
s hold
iv. Agricultur
al land
v. Investme
nt in real
estate
such as
booking
of plots,
flats and
other
immovabl
e
propertie
s in your
name or
in joint
names.
vi. Other
propertie
s.

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
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 descriptions
and indicate
estimated
market value
of your
interest
deducting
without
encumbrance
s or costs of
disposition.
(Record
encumbrance
s under debts)

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.
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 (iii) Whether
any litigation
pending with
respect to the
joint
property? If
so, give
particulars.

63. Liquid assets: Accoun Name of Current

t bank balance
numbe
i. Details of r
all bank
accounts a. 104 State bank
including 849 of India
Current, 766
Savings 88 Canara
and b. 034 Bank
Demat 910
Accounts 103
in your 651
name, or 9
joint
name and
balance
in the
said
account.

ii. Cash in
hand
64. Investments

(i) Details of

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 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
Governm
ent and
entities
non-
governm
ent
c) Stocks,
shares,
debentur
es,
bonds,
units and
mutual
funds,
etc.
d) Stocks,
shares,
debentur
es,
bonds,
units and
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 mutual
funds,
etc.
e) Loan
given to
friends,
relatives
and
others
f) Other
investme
nts not
covered
by above
items

65. Pensions and Particulars Maturity

Retirement amount
Savings Plan

Indicate name
of institution
where
accounts are
held, name
and address
of pension
plan and
pension
details.
66. Corporate/ Particulars Current value
Business
Interests

List any
interest you
hold, directly
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 or indirectly,
in any
corporation,
unincorporate
d business,
partnership,
trust, joint
venture and
Association of
Persons,
Society etc.
67. Movable Particulars Current value
Assets
i. Motor
Vehicles
(List cars,
motorcycl
es,
scooters
etc. along
with their
brand
and
registrati
on
number)
ii. Livestock
iii. Mobile
phone(s)
iv. Computer
/Laptop
v. Other
electronic
gadgets
including
I-pad etc.
vi. TV,
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 Fridge,
Air
Condition
er,
Microwav
e,
washing
machine,
etc.
vii. Other
househol
d and
kitchen
appliance
s
viii. Quantity
of gold,
silver and
diamond
jewellery
ix. Quantity
of Silver
Utensils
68. Intangible
Properties

Including
patents,
trademark,
copyright
design and
goodwill and
their value
69. About Particulars Present
disposal of estimated
properties market value

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 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.

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PART – VII
STATEMENT OF LIABILITIES
S.NO. Description Particulars Current
of debts 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.

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 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
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 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
EXPENTITURE
PART A
DOCUMENTS RELATING TO PERSONAL INFORMATION
S.NO. Description
1. Ration card
2. Voter ID card
3. Aadhar card
4. Driving license
5. PAN card
6. Passport

PART B
DOCUMENTS RELATING TO INCOME, ASSETS AND
LIABILITIES
S.NO Description Please Tick
. Attach Not To
ed Applicab follo
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 le w
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
10. In case of self-employed
persons
(i) Balance Sheet
and Profit & Loss
Account
(ii) Balance Sheet
and Profit & Loss
Account of the
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 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
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 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
Agreement(s)
Deed(s)/Rent
/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
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 documents in
respect of the
profit on sale of
property/propert
ies
12. Other relevant
documents relating to
Income/Assets
13. Other relevant
documents relating to
liabilities
PART C
DOCUMENTS RELATING TO EXPENDITURE
14. (i) Documents relating to
the expenditure on
education of children
including tuition fees

(ii) Rent and maintenance

receipts

(iii) Electricity, water,

security and gas bills

(iv) Documents relating to

the salary paid to the
employees including
domestic helper(s)

(v) Documents relating

expenditure on
conveyance to

(vi) Debit and Credit Card

statements of all cards

(vii) Frequent Flier's Card

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 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.

DEPONDENT

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Verification:

Verified at New Delhi on this 4th day of

December 2024 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.

DEPONDENT

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