Section 12 DV Act Format

APPLICATION TO THE MAGISTRATE UNDER SECTION 12 OF THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005 (43 OF 2005)
To
The Court of Judicial Magistrate
…………………………………………..
…………………………………………..
…………………………………………..
Application under the Protection of Women from Domestic Violence Act, 2005 (43 of 2005). The applicant submits as under:

1. That the application under section ……… .. of Protection of Women from Domestic Violence Act, 2005 is being filed along with a copy of Domestic Incident Report by the:—
   (a) Aggrieved person [ ]
   (b) Protection Officer [ ]
   (c) Any other person on behalf of the aggrieved person [ ]
   (tick whichever is applicable)
2. It is prayed that the Hon’ble Court may take cognizance of the complaint/Domestic Incident Report and pass all/any of the orders, as deemed necessary in the circumstances of the case.
   (a) Pass protection orders under section 18 and/ or
   (b) Pass residence orders under section 19 and/ or
   (c) Direct the respondent to pay monetary relief under section 20 and/ or
   (d) Pass orders under section 21 of the Act and/ or
   (e) Direct the respondent to grant compensation or damages under section 22 and/ or
   (f) Pass such interim orders as the Court deems just and proper
   (g) Pass any orders as deems fit in the circumstances of the case.
3. Orders required:
   (i) Protection Order under section 18:
   [ ] Prohibiting acts of domestic violence by granting an injunction against the Respondent/s from repeating any of the acts mentioned in terms of Column 4(a)/(b)/(C)/(d)/(e)/(f)/(g) of the application
   [ ] Prohibiting Respondent(s) from entering the school/college/workplace
   [ ] Prohibiting from stopping the applicant from going to applicant’s place of employment
   [ ] Prohibiting Respondent(s) from entering the school/college/any other place of children of the applicant
   [ ] Prohibiting from stopping the applicant from going to applicant’s school
   [ ] Prohibiting any form of communication by the Respondent with the applicant
   [ ] Prohibiting alienation of assets by the Respondent
   [ ] Prohibiting operation of joint bank lockers/accounts by the Respondent and allowing the aggrieved person to operate the same
   [ ] Directing the Respondent to stay away from the dependants/relatives/ any other person of the aggrieved person to prohibit violence against them
   [ ] Any other order, please specify ………………………….. ..
   (ii) Residence/Order under section 19
   An order restraining Respondent(s) from:
   [ ] Dispossessing or throwing out the applicant from the shared household
   [ ] Entering that portion of the shared household in which the applicant resides
   [ ] Alienating/disposing/encumbering the shared household
   [ ] Renouncing his rights in the shared household
   [ ] An order entitling the applicant continued access to personal effects of the applicant
   [ ] An order directing Respondent(s) to
   Remove himself from the shared household
   Secure same level of alternate accommodation or pay rent for the same
   [ ] Any other order, please specify …………………………………….. ..
   (iii) Monetary reliefs under section 20
   [ ] Loss of earnings, amount claimed …………………. ..
   [ ] Medical expenses, amount claimed
   [ ] Loss due to destruction/ damage or removal of property from the control of the aggrieved person, amount claimed
   [ ] Any other loss or physical or mental injury as specified in clause 10(d), amount claimed ………………….. ..
   [ ] Total amount claimed
   [ ] Any other order please specify
   (iv) Monetary reliefs under section 20
   [ ] Directing the Respondent to pay the following expenses as monetary relief
   [ ] Food, clothes, medications andother basic necessities amount …………… .. per month
   [ ] School fees and related expenses amount ……………. .. per month
   [ ] Household expenses amount …………… .. per month
   [ ] Any other expenses amount …………… .. per month
   Total ……………. .. per month
   [ ] Any other order please specify ……………………………………………………… ..
   (v) Custody Order under section 21
   Direct the Respondent to hand over the custody of the child or children to the-
   [ ] Aggrieved person-applicant
   [ ] Any other person on her behalf, details of such person ……………………………………..
   (vi) Compensation Order under section 22
   (vii) Any other order, please specify …………………………………………….. ..
4. Details of previous litigation, if any
   (a) [ ] Under the Indian Penal Code, sections ………………. .. Pending in the Court of ……………………………………………… ..
   [ ] Disposed of, details of relief ………………………………………………… ..
   (b) [ ] Under Code of Criminal Procedure, sections ………………. .. Pending in the Court of ………………………………………………………….
   [ ] Disposed of, details of relief ………………………………………… ..
   (c) [ ] Under the Hindu Marriage Act, 1956, …. ………….. .. Pending in the Court of ……………………………………………………….. ..
   [ ] Disposed of, details of relief ………………………………………………… ..
   (d) [ ] Under the Hindu Adoptions and Maintenance Act, 1956, sections ……. .. Pending in the Court of
   [ ] Disposed of, details of relief ……………………………………………….. ..
   (e) [ ] Application for maintenance, under section …… .. under ……… .. Act Interim maintenance Rs …………………………. .. p.m.
   Maintenance granted Rs …………………………. .. p.m.
   (f) [ ] Whether Respondent was sent to Judicial Custody
   [ ] For less than a week
   [ ] For less than a month
   [ ] For more than a month
   Specify period …………………………………………………………………… ..
   (g) Any other order ………………………………………………………………. ..
   Prayer: It is, therefore, most respectfully prayed that this Hon’ble Court be pleased to grant the relief(s) claimed therein and pass such order or orders / other order as this Hon’ble Court may deem fit and proper under the given facts and circumstances of the case for protecting the aggrieved person — the applicant from domestic violence and in the interest of justice.
   Place ………….. ..
   Date ………….. .. COMPLAINANT/AGGRIEVED PERSON
   THROUGH COUNSEL
   VERIFICATION
   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 nothing material has been concealed therefrom.
   DEPONENT
   ……………………………………………………………………..
   Counter-signature of Protection Officer with date

How to file a complaint under section 12 of the Protection of Women from Domestic Violence Act, 2005 (D.V. Act, 2005)

To file a complaint under Section 12 of the Protection of Women from Domestic Violence Act, 2005 (D.V. Act, 2005), follow these steps:

1. Identify the Aggrieved Person: The complaint can be filed by any woman who has lived in a shared household with the respondent, including a wife, mother, sister or woman in a live-in relationship.
2. Draft the Complaint: When drafting the complaint, ensure it includes:
   • The relationship between the aggrieved person and the respondent.
   • The nature of domestic violence suffered, including physical, emotional or economic abuse.
   • Specific incidents with dates and details.
3. Mention Reliefs Sought: Clearly state the reliefs you are seeking under the Act, such as:
   • Protection Order (Section 18): Preventing the respondent from committing further acts of violence.
   • Residence Order (Section 19): Ensuring the aggrieved person has a place to stay in the shared household.
   • Monetary Relief (Section 20): Compensation for expenses incurred due to domestic violence.
   • Custody Orders (Section 21): Custody of children, if applicable.
   • Compensation Order (Section 22): Compensation for injuries, including mental trauma.
4. Interim Applications: Given that legal proceedings can be lengthy, it’s advisable to file an interim or ex-parte application to seek immediate relief for protection, residence, monetary support andother applicable orders.
5. File the Complaint: Submit the complaint to the court with jurisdiction, which may be the location where the aggrieved person resides (either permanently or temporarily), where the respondent resides or where the cause of action arose.
6. Court Procedure:
   • Admission of Complaint: Upon admission, the court will issue notice to the Protection Officer, who will meet the aggrieved person, prepare a Domestic Incident Report (DIR) andsubmit it to the court.
   • Issuance of Notice to Respondent: In urgent cases, notices may be issued to the respondents at the admission stage, even before the DIR is submitted.
   • Mediation: The court will send both parties for mediation. If mediation fails, the case is referred back to the court.
   • Income Affidavit Submission: The complainant must submit an income affidavit and bank statement. The respondent must reply with their own income affidavit.
   • Decision on Maintenance: The court will determine the maintenance amount to be paid to the aggrieved person based on the submitted affidavits.
7. Court Fees: The amount of court fees and other charges may vary depending on the jurisdiction. Ensure you are aware of the applicable fees in the court where you are filing the complaint.

By following these steps, you can effectively file a complaint under Section 12 of the D.V. Act, 2005, ensuring all necessary reliefs are sought to protect the aggrieved person’s rights and well-being.