IN THE COUR OF CHIEF JUDICIAL MAGISTRATE FIRST

CLASS, DISTRICT COURTS, SONIPAT

RUBY AND ANR. ….Complainant

VERSUS

NANDAN AND ORS. ….Respondents

AFFIDAVIT OF ASSETS AND LIABILITIES FOR NON-

AGRARIAN DEPONENTS

Smt. Ruby W/o Sh. Nandan D/o Sh. Late Suman Das R/o H.No
400,Sector 14,Sonepat,Haryana-131001, do hereby affirm and declare as
under:-

A. PERSONAL INFORMATION

Sr. Particulars
No.
1. Name Ruby
2. Sex/Age Female/age 26 years
3. Qualification (Educational and
Professional)
4. Whether the applicant is staying in the Sonipat
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 10.05.2016
6. Date of Separation 24.09.2024
7. General monthly expenses of the Rs. 30,000/- (Thirty
applicant (Rent, household expenses, thousand only)
medical bills, transportation, etc.
B. DETAILS OF LEGAL PROCEEDINGS AND MAINTENANCE
BEING PAID

Sr. Particulars
No.
1. Particulars of any ongoing or past legal proceedings with NIL
respect to maintenance or child support between the
applicant and non-applicant.
2. Whether any maintenance has been awarded in any No
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, along with a copy of the No
order/s passed.
4. Whether the order of earlier proceedings has been No
complied with. If not, arrears of maintenance.
5. Whether any voluntary contribution towards maintenance NIL
has been made/ will be made in the future? If yes, provide
details of same.

C. DETAILS OF DEPENDENT FAMILY MEMBERS

Sr. Particulars
No.
1. Details of dependent family members, if any Son –Prince
a) Relationship with dependent/s: Age- 7 yrs
b) Age and Sex of dependent/s:
2. Disclose if any independent source/s of income of NA
the dependants, including interest income, assets,
pension, tax liability on any such income and any
other income relevant detail.
3. The approximately income incurred on the NA
maintanance the dependant

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

DEPENDANT FAMILY MEMBERS.
Sr. Particulars
No.
1. Whether either party or child/ children is suffering NA
from any physical/ mental disability, or any other
serious ailment. If yes, produce medical records.
2. Whether any dependant family member has serious NA
disability, requiring continuous medical
expenditure. If yes, produce disability certificate
and approximate medical expenditure incurred on
such medial treatment.
3. Whether either party or child/ children or any other NA
dependant 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 Parties

Sr. Particulars
No.
1. Number of children from the existing Two
marriage or marital relationship previous
marriage
2. Name and age of children  Son –Prince
Age- 7 yrs

 Son- Golu
Age-6 yrs
3. Details of the parent who has the custody Prince is in custody
of the children. of complainant and
Golu is in custody of
Respondent No. 1
4. Expenditure for the maintenance of the Details of
dependant children. expenditure
a. Towards food, clothing and medical
expenditure. a. Food= around
b. Towards expenses for education, and a 15,000/-
 summary of general expenses.
c. Towards expenses, if any, of any extra b. Clothing= around
educational, vocational or professional/ 5,000/-
educational course, specialized training or
special skills programme of dependant c. Medical= around
children. 2,000/-
d. Details of any loan, mortgage, charge
incurred or instalment plan (Being paid or d. Rent – 7000/-
payable), if any, on account of any
educational expenses of children.

5. Whether any voluntary contribution by NA

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 Brother and Elder
provided by a third party for the sister of complainant
educational expenses of the children?

F. DETAILS OF INCOME OF THE DEPONENT

Sr. Particulars
No.
1. Name of employer NA
2. Designation NA
3. Monthly income NA
4. If engaged in government services, furnish latest NA
salary certificates or current pay slips of proof of
deposit in the bank account, if being remitted
directly by the employer.
5. If engaged in the private sector, furnish a certificate NA
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, NA
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 NA
copies of the income tax returns for the periods
given below:
a) One year prior to marriage
b) One year prior to separation
c) At the time when the application for maintenance
is filed.
8. Income from other sources, such as rent, interest, NA
shares, dividends, capital gains, FDR’s, 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 statements of all accounts NA
for the last 3 years.

G. ASSESTS (MOVABLE AND IMMOVABLE) OWNED BY THE

DEPONENT

Sr. Particulars
No.
1. Self acquired property, if any: NA
2. Property jointly owned by the parties after marriage: NA
3. Share in any ancestral property. NA
4. Other joint properties of the parties NA
(account/investments/FDR/ Mutual funds, stocks,
debentures ETC.) their value and status of
possession:
5. Status of possession of immovable property and NA
details of rent, if leased:
6. Details of loans taken or given by the deponent NA
7. Brief description of jewellery and ornaments of NA
parties acquired during/ after marriage.
8. Details of transfer deeds or transactions of alienation NA
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 LIABILITES OF THE DEPONENT

Sr. Particulars
No.
1. Loans, Liabilities, Mortgage, or charge outstanding NA
against the deponent, if any.
2. Details of any EMIs being paid. NA
3. Date and purpose of taking loan or incurring any NA
such liability:
4. Actual amount borrowed, if any, and the amount NA
paid upto date of filing the affidavit.
5. Any other information which would be relevant to NA
describe current liabilities of the deponent.

I. SELF EMPLOYED PERSONS/PROFESSIONALS/ BUSINESS

PERSONS/ ENTREPRENEUR.

Sr. Particulars
No
.
1. Brief description of nature of NA
business/profession/vocation/self employed/ work activity.
2. Whether the business/profession/self employment is carried NA
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
applicants share in the partnership/business/ professional
association/ self employment. In case of partnership, specify
the share in the profit/loss of the partnership.
3. Net income from the business/profession/ partnership/self NA
employment.
4. Business/partnership/self employment liabilities, if any, in NA
case of such activity.
5. In case of business of a company, provide brief details of last NA
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 NA
the last income tax return of partnership.
7. In case of self employed individual, provide the filings of the NA
last income tax return from any
such/professional/business/vocational activity.

J. INFROMATION PROVIDED BY THE DEPONENT WITH

RESPECT TO THE INCOME, ASSETS AND LIABILITES OF
THE OTHER SPOUSE.

Sr. Particulars
NO.
1. Educational and professional qualification of NOT KNOWN
the other spouse:
2. Whether spouse is earning? If so, give Yes, working as
particulars of the occupation and income of contractor in
the spouse. white wash work
and earning
approx. 50,000 –
60,000 per month
3. If not, whether he/she is staying in his/her own Not Known
accommodation, or in a rented
accommodation or in accommodation
provided by employer/business/partnership?
4. Particulars of assets and liabilities of spouse as Not Know
known to the deponent, along with any
supporting documents.

K. DETAILS OF APPLICANT OR OTHER SPOUSE, IN CASE

PARTIES ARE NON-RESIDENT INDIANS, OVERSEAS
CITIZENS OF INDIA, FOREIGN NATIONALS OR PERSONS
LIVING ABROAD OUTSIDE INDIA.

Sr. Particulars
No.
1. Details of citizenship, nationality and current place NA
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 NA
foreign currency of such applicant/spouse, duly
 supported by relevant documentation of
employment and income from such foreign
employer or overseas institution or latest relevant
bank statement.
3. Details of household and other expenditure of such NA
applicant/spouse in foreign jurisdiction.
4. Detials of tax liability of applicant/other spouse in NA
foreign jurisdiction.
5. Details of income of applicant/other spouse from NA
other sources in India/ Foreign jurisdiction.
6. Details of expenses incurred or contribution made NA
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, NA
not covered under any of the above headings and
any other liabilities to any other dependant family
members in India or Abroad.

DELCARATION

1. I declare that I have made full and accurate voluntary disclosure of

my income, expenditure, assets and liabilities form all sources, I
further declare 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 expenses or any other
information included in this affidavit.
3. I understand that any false statement in this affidavit my 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.

Verification:

Deponent

Verified at Sonipat on this 9 th day of December, 2024 that

the contents of 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 there from, 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 affidavit are the copies of
the originals.

Deponent