Affidavit format under Section 23(2) of The Protection of Women from Domestic Violence Act, 2005


CASE NO. __________ OF 20__


MRS. W_________                                                             COMPLAINANT


MR. H __________                                                           RESPONDENT

Police Station : _________________


I, __________________ Wife of Mr. ________________ Resident of______________________________, D/o Mr. _________________R/o__________________________ presently residing at____________ do solemnly affirm and declare on oath as under:

1. That I am the Applicant in the accompanying Application for ____________ filed for myself and for my daughter / son.

2. That I am the Natural guardian of ______________________________.

3. That being conversant with the facts and circumstances of the case I am competent to swear this Affidavit.

4. That the Deponent had been living with the Respondent at _________ since ______ to ________

5. That the details provided in the present Application for the grant of relief under Section (s) _________ have been entered into by the Deponent / at my instructions.

6. That the contents of the said application have been read over, explained to me in English/ Hindi / any other local language (Please specify ______________)

7. That the contents of the said application may be read as part of this affidavit and are not being repeated herein for the sake of brevity.

8. That the Applicant apprehends repetition of the acts of domestic violence by the Respondent (s) against which relief is sought in the accompanying application.

9. That the Respondent has threatened the applicant that ________________

10. That the relief claimed in the accompanying application are urgent in as much as the applicant would face great financial hardship and would be forced to live under threat of repetition / escalation of acts of domestic violence complained of in the accompanying application by the Respondent (s) if the said reliefs are not granted on the ex parte ad interim basis.

11. That the facts mentioned herein are true and correct to the best of my knowledge and belief and nothing material has been concealed therefrom.



Verified at ____________ (Place) on this___ day of ___________ that the contents of Paras 1 to 12 of the above application are true and correct to the best of my knowledge and belief nothing in Material has been concealed therefrom.