Income Affidavit Form or Assets Affidavit Form Sample for Child Custody

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IN THE COURT OF…………………… , …………………. COURT, …………………. DV NO. ……. OF 20.. 

IN THE MATTER OF: 

ABC …COMPLAINANT Versus 

XYZ …RESPONDENTS AFFIDAVIT 

I, ………. , wife of ………….., daughter of …………., aged about …… years,  resident of ……………………………., do hereby solemnly affirm and declare as  under :- 

PART – I 

PERSONAL INFORMATION RELATING TO THE DEPONENT

S.  No.Description Particulars
1. Name ……………
2. Age …….. years
3. Residential Address …………………………………………….. ……………………………………………..
4. E-mail Address …………………….
5. Date of marriage ……20..
6. Date of separation ……20..
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?Yes/No
13. Whether you have sufficient  income to support yourself?Yes/No
14. If not, whether you have claimed  maintenance from your spouse?Yes/No 
15. Whether you are staying at  matrimonial home?Yes/No
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? N.A. 
19. Whether you have voluntarily paid  or willing to pay maintenance to  your spouse? If so, how much?N.A.
20. Whether you are willing to pay  litigation expenses to your spouse?  If so, how much?Yes/No
21. Particulars of pending litigation  between the parties(i) …………………………………………… (ii)…………………………………………… (iii) …………………………………….
22. Whether any maintenance order  has been passed by any Court? If  so, give particulars and attach copy  of the order?Yes/No
23. Whether the maintenance is being  paid in terms of the aforesaid  order? If so, file the statement of  maintenance paid upto dateYes/No
24. Expenses incurred on this litigation Approx. Rs. ………………………
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 ………………………………. Email: ………………………… Ph. …………………………

PART – II 

RELEVANT INFORMATION RELATING TO THE SPOUSE 

S. No. Description Particulars
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.Yes/No
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?Yes/No
30. Particulars of the assets and liabilities of your  spouseYes/No
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?Yes/No

PART – III 

RELEVANT INFORMATION RELATING TO THE CHILDREN

S. No. Description Particulars
32. Children from the marriage with their name and  age Yes/No
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
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 children Amount
(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)

PART-IV 

STATEMENT OF INCOME

S. No. Description Particulars
40. In case of salaried persons:
Designation
Name and address of the employer
Date of employment
Gross Income including the salary, D.A.,  commissions/incentives, bonus, perks etc.
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
Deductions from the gross income
Income Tax paid
Net income
Value of stock option benefits if provided by the  employer
Pension and retirement benefits payable at the  time of retirement
41. In case of self-employed persons: 
Nature of business/profession
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
Number of employees
Annual turnover/gross receipts
Gross Profit
Net Income
Income Tax
Details and value of benefits in kind, perks or  other remuneration e.g. provision of car,  payment of accommodation etc.
Amount of regular monthly withdrawal or  drawings
42. In case the business/ profession is carried on as  a Partnership Firm/Company :
Registered /Corporate Office of the 
firm/company
Information and particulars with regard to your  shareholding, involvement in the affairs and  management of the firm/company
Director’s/ Partner’s remuneration : –
a) Salary
b) Interest
c) Rent
d) Commission
e) Others 
List of all the bank accounts of the  firm/company
Location of the statutory records and books of  account of the firm/company 
List of immovable assets, land and building etc.  of the firm/company. 
Number of workmen/employees
Current value of your business interest(s) 
Current value of your business assets 
List of directorships held, sitting fees,  commission or any other remuneration
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 : 
Agricultural Income 
Rent 
Interest on bank deposits and FDRs 
Interest on investments including deposits,  NSC, IVP, KVP, Post Office schemes, PPF,  loans etc.
Dividends
Mutual Funds
Annuities
Lease of machinery, plant or furniture
Sale of movable/ immovable assets
Gifts
44. Any other income not covered above
45. TOTAL INCOME (Give monthly income)

PART-V 

STATEMENT OF EXPENDITURE

S. No. Description Particulars
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.
(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  and recreation(i) Club
(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) Instalment 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 (Teacher Training Course) 
60. TOTAL EXPENDITURE (Give monthly  expenditure)

PART – VISTATEMENT OF ASSETS

S.  No.Assets List of Assets
At the  time of  marriageAt the  time of  Separatio nPresent Present  Estimated  Market  Value
61. Real Estate Including
Land
Built up properties
Lease hold properties
Agricultural land
Investment in real  estate such as booking  of plots, flats and other  immovable properties  in your name or in  joint names.
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.)
62. Joint Properties N.A.
Properties presented at  or about the time of  marriage, which 
belong jointly to both  the husband and wife.  Give the status of their  possession.
Other joint properties  of the parties. Give the  status of their  possession.
Whether any litigation  pending with respect  to the joint property?  If so, give particulars.
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 accountAccount  NumberName of the  BankCurrent  Balance
(i)
(ii)
(iii)
(iv)
(ii) Cash in hand
64. Investments: Details  of all investments you  hold or, in which you  have interest and their  current value:Particulars Current Value
FDRs, NSC, IVP,  KVP, Post Office  schemes, PPF etc.
Deposits with  Government and Non Government entities
Stocks, shares,  debentures, bonds,  units and mutual  funds, etc.
Life and endowment  policies and surrender  value
Loan given to friends,  relatives and others
Other investments not  covered by above  items
65. Pensions and  Retirement Savings  Plan Indicate name of  institution where  accounts are held,  name and address of  pension plan and  pension detailsParticulars Maturity Amount
66. Corporate/Business  Interests List any interest you  hold, directly or  indirectly, in any  corporation,  unincorporated  business, partnership,  trust, joint venture and  Association of  Persons, Society etc.Particulars Current Value
67. Movable Assets Particulars Current Value
Motor Vehicles (List  cars, motorcycles,  scooters etc. along 
with their brand and  registration number)
Livestock
Mobile phone(s)
Computer/Laptop
Other electronic  gadgets including I – pad etc.
TV, Fridge, Air  Conditioner,  Microwave, Washing  machine, etc. (all with  the Respondent in  Delhi/ Dubai)
Other household and  kitchen appliances
Quantity of gold, platinum, silver and  diamond jewellery p
All Jewellery in Possession of the Respondent.
Quantity of Silver  Utensils
All Silver utensils in Possession of The Respondent.
68. Intangible properties Including patents,  trademark, copyright  design and goodwill  and their valueParticulars Present Estimated  Market Value
N.A.
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 purchaserParticulars 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

S. No. Description Particulars of  DebtsCurrent 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. 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
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. Descriptions
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
8. Income Tax Return(s)  along with Statement of  Income for last 3 years
9. In case of Salaried  Persons
Appointment letter along  with salary structure at  time of appointment.
Last Salary Slip
Forms 16, 16A , 12BA &  26AS
Cost to Company  Certificate and CIBIL  Certificate, wherever  applicable
Copies of TDS certificates
10. In case of self-employed  persons
Balance Sheet and Profit  & Loss Account
Balance Sheet and Profit  & Loss Account of the  proprietorship firm, if the  business is carried on in  the name of a sole  proprietorship concern
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
Balance Sheet and Profit  & Loss Account of the  Company in which the  deponent is a Director
Balance Sheet and Profit  & Loss Account of the  Association of Persons,  HUF, Joint Family  business or trust in which  the deponent has share
Copy of account of the  deponent in the books of  the business
Copies of TDS certificates
11. In case of Income from  other sources:
Lease Deed(s)/Rent  Agreement(s) /Licence  Agreement(s) in respect of  the rental income
Interest Certificate in  respect of the interest  income on deposits and  investments
Dividend Certificates in  respect of dividend income
Demat holding Statement
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
14. Description Please Tick
Attached Not Applicable To Follow
Documents relating to the  expenditure on education  of children including  tuition fees
Rent and maintenance  receipts
Electricity, water, security  and gas bills
Documents relating to the  salary paid to the  employees including  domestic helper(s)
Documents relating to  expenditure on  conveyance
Debit and Credit Card  statements of all cards
Frequent Flier’s Card  statements
Mobile and landline phone  bills
Internet and TV cable/ Set 
– Top Box bills
Documents relating to the  re – payment of the loans
PPF, EPF and other  superannuation fund  receipts
Receipts of premium of  insurance policies
Receipts of payments in  respect of mutual funds
Documents relating to  payment of interest on  bank and other loans
Documents relating to the  payment of taxes,  including Income Tax and  Property Tax
Other relevant documents  relating to Expenditure

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 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 the affidavit are true copies  of the originals.  

DEPONENT

Child Custody

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