Application for protection from domestic violence — s.12, Domestic Violence Act, 2005

दस्तावेज़

In the Court of the Learned Judicial Magistrate First Class / Metropolitan Magistrate, ________________

Case No. ........ of ........

________________, resident of ________________             ...... Aggrieved person / Applicant
versus
________________, resident of ________________   ...... Respondent

APPLICATION UNDER SECTION 12 OF THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005

Made under: Section 12 of the Protection of Women from Domestic Violence Act, 2005; reliefs under Section 18 (protection order), 19 (residence order), 20 (monetary relief), 21 (custody order) and 22 (compensation).

The applicant respectfully submits:

1. The applicant's relationship with the respondent: ________________. They lived / live together in a shared household.

2. The acts of domestic violence (physical, sexual, verbal and emotional, economic — Section 3), with dates:
________________

3. A Domestic Incident Report has / has not been recorded with the Protection Officer (particulars: ........).

4. The reliefs sought:
________________

PRAYER: It is prayed that the above reliefs be granted, and that an immediate ex parte interim order be passed (Section 23).

Applicant
________________
Place: ________________
Date: ________________