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Domestic Violence Application Format under Section 12 of the DV Act

Sections 12, 18 to 23 and 27, Protection of Women from Domestic Violence Act, 2005; Rule 6, Protection of Women from Domestic Violence Rules, 2006

Free sample · Word, print and copy · Updated

Sample format, not legal advice. This is a sample format for general information. It is not legal advice and does not create a lawyer–client relationship. Facts, court practice, court fees and stamp duty differ by state and by case. Check the current law and your local court rules, or speak to an advocate, before you file, send or sign it.

An application under Section 12 of the Protection of Women from Domestic Violence Act, 2005 (DV Act) is filed by a woman who has faced domestic violence from a person she lives, or has lived, with in a shared household — a husband, a partner in a relationship in the nature of marriage, in-laws, or other relatives. It asks the Magistrate for civil reliefs: protection, residence, monetary relief, custody and compensation.

The DV Act is a civil remedy heard by a criminal court. It is different from an FIR for cruelty under Sections 85 and 86 of the Bharatiya Nyaya Sanhita, 2023 [Section 498A IPC], which leads to a criminal trial and punishment. A woman can use both. The Act protects women of every religion. After Hiral P. Harsora v. Kusum Narottamdas Harsora (2016), the respondent need not be an adult male, so female relatives of the husband can also be made respondents.

Filed before
Judicial Magistrate First Class or Metropolitan Magistrate (S.27)
Filed by
The aggrieved woman, a Protection Officer, or any person on her behalf
Where
Where she resides (even temporarily), works or carries on business, where the respondent resides, or where the violence occurred
Time limit
No limitation period is prescribed for a Section 12 application
First hearing
Ordinarily within 3 days of receipt; disposal within 60 days of the first hearing (S.12(4)–(5))
Court fee
Nil or nominal, depending on state rules

When to use this format

  • A woman is being physically, sexually, verbally, emotionally or economically abused by her husband or his family.
  • She has been thrown out of, or is about to be thrown out of, the matrimonial home or another shared household.
  • Her stridhan, jewellery or documents are being withheld by the husband or in-laws.
  • She needs urgent money for herself and her children, or custody of a child, while the matter is pending.
  • If only maintenance is needed and there is no violence, a maintenance application under Section 144 BNSS may be simpler.

Application under Section 12 of the DV Act

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Replace everything in [square brackets] with your own details. Delete lines that do not apply.

IN THE COURT OF THE [JUDICIAL MAGISTRATE FIRST CLASS / METROPOLITAN MAGISTRATE], [PLACE], [STATE]

Complaint Case (DV) No. ______ of [YEAR]

IN THE MATTER OF:

[NAME OF AGGRIEVED PERSON]
W/o / D/o [NAME]
Aged about [AGE] years
R/o [PRESENT ADDRESS WITH PIN]
Mobile: [MOBILE NUMBER]
... Aggrieved Person / Applicant

Versus

1. [NAME OF RESPONDENT NO. 1]
S/o [FATHER'S NAME]
[RELATIONSHIP, e.g. husband]
R/o [ADDRESS]

2. [NAME OF RESPONDENT NO. 2]
[RELATIONSHIP, e.g. mother-in-law]
R/o [ADDRESS]

3. [NAME OF RESPONDENT NO. 3, IF ANY]
[RELATIONSHIP]
R/o [ADDRESS]
... Respondents

APPLICATION UNDER SECTION 12 OF THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005, READ WITH RULE 6(1) OF THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE RULES, 2006, SEEKING RELIEFS UNDER SECTIONS 18, 19, 20, 21 AND 22, AND INTERIM AND EX PARTE ORDERS UNDER SECTION 23 OF THE ACT

MOST RESPECTFULLY SHOWETH:

1. That the Applicant is the [WIFE / DAUGHTER-IN-LAW / SISTER / MOTHER / WOMAN IN A RELATIONSHIP IN THE NATURE OF MARRIAGE] of Respondent No. 1. [The Applicant and Respondent No. 1 were married on [DATE] at [PLACE] according to [RITES / LAW].] Respondent No. 2 is the [RELATIONSHIP] and Respondent No. 3 is the [RELATIONSHIP] of Respondent No. 1.

2. That the Applicant has lived with the Respondents in a domestic relationship within the meaning of Section 2(f) of the Act, in the shared household at [FULL ADDRESS OF SHARED HOUSEHOLD], from [DATE] to [DATE / TILL DATE]. The said household is [OWNED BY / RENTED BY / IN THE NAME OF] [NAME].

3. That [NO CHILD WAS BORN OF THE MARRIAGE] / [THE FOLLOWING CHILD(REN) WERE BORN: [NAME], aged [AGE], presently living with [THE APPLICANT / RESPONDENT NO. 1]].

4. That the Respondents have committed domestic violence against the Applicant within the meaning of Section 3 of the Act, as set out below, in the order in which the incidents occurred:

(a) Physical violence: [DATE, PLACE, WHAT HAPPENED, WHICH RESPONDENT, INJURIES, MEDICAL TREATMENT].

(b) Sexual violence: [DETAILS, IF ANY].

(c) Verbal and emotional abuse: [INSULTS, NAME-CALLING, THREATS, TAUNTS ABOUT DOWRY OR NOT HAVING A CHILD OR A MALE CHILD, WITH DATES AND THE RESPONDENT CONCERNED].

(d) Economic abuse: [DEPRIVATION OF MONEY FOR HOUSEHOLD OR MEDICAL NEEDS / TAKING AWAY SALARY / WITHHOLDING STRIDHAN AND JEWELLERY / PREVENTING ACCESS TO THE SHARED HOUSEHOLD].

(e) Dowry demands: [DEMANDS MADE, BY WHOM, ON WHAT DATES, AND HARASSMENT FOR NOT MEETING THEM].

5. That the last act of domestic violence took place on [DATE], when [DESCRIBE]. [The Applicant was thrown out of / forced to leave the shared household on [DATE] and is now living at [ADDRESS].]

6. That the Applicant [MADE A COMPLAINT TO THE POLICE / WOMEN'S CELL / PROTECTION OFFICER ON [DATE], REFERENCE [NUMBER]] / [HAS NOT MADE ANY EARLIER COMPLAINT BECAUSE [REASON]]. [A Domestic Incident Report dated [DATE] has been prepared by the Protection Officer, [NAME / DISTRICT], and a copy is annexed.]

7. That the following other proceedings between the parties are pending or decided: [FIR NO. [NUMBER] UNDER SECTIONS 85/86 BNS [498A IPC] AT POLICE STATION [NAME] / MAINTENANCE CASE UNDER SECTION 144 BNSS / DIVORCE PETITION / NONE].

8. That the Applicant has no independent income [OR: earns Rs. [AMOUNT] per month, which is insufficient]. Respondent No. 1 is employed as [DESIGNATION] with [EMPLOYER] and earns about Rs. [AMOUNT] per month, besides [OTHER ASSETS / INCOME]. The Applicant's monthly needs are: food and household Rs. [AMOUNT]; rent Rs. [AMOUNT]; medical Rs. [AMOUNT]; child's education and needs Rs. [AMOUNT]; total Rs. [AMOUNT].

9. That the Applicant has suffered [INJURIES / MEDICAL EXPENSES OF RS. [AMOUNT] / LOSS OF EARNINGS / LOSS OR DAMAGE TO PROPERTY] and severe mental and emotional distress because of the Respondents' acts.

10. That the Applicant apprehends further violence, dispossession from the shared household and alienation of her stridhan, and seeks urgent interim orders. An affidavit under Section 23(2) of the Act is filed with this application.

11. That this Hon'ble Court has jurisdiction under Section 27 of the Act because [THE APPLICANT PERMANENTLY OR TEMPORARILY RESIDES / THE RESPONDENTS RESIDE / THE CAUSE OF ACTION AROSE] at [PLACE], within the local limits of this Court.

PRAYER

It is therefore most respectfully prayed that this Hon'ble Court may be pleased to grant the following reliefs:

(a) a protection order under Section 18 prohibiting the Respondents from committing any act of domestic violence, from contacting or communicating with the Applicant, from entering her place of work [or the child's school], and from alienating any assets or operating joint bank accounts or lockers without the Court's leave;

(b) a residence order under Section 19 [restraining the Respondents from dispossessing the Applicant from the shared household at [ADDRESS] / directing the Respondents to restore the Applicant to the shared household / directing Respondent No. 1 to secure alternative accommodation of the same standard or to pay rent of Rs. [AMOUNT] per month];

(c) a direction under Section 19(8) to return the Applicant's stridhan, jewellery, documents and articles listed in Annexure [NUMBER];

(d) monetary relief under Section 20 of Rs. [AMOUNT] per month as maintenance for the Applicant [and the child], and reimbursement of Rs. [AMOUNT] towards medical expenses and loss of earnings;

(e) temporary custody of the minor child [NAME] under Section 21 [with suitable visitation arrangements];

(f) compensation and damages of Rs. [AMOUNT] under Section 22 for the injuries, including mental torture and emotional distress, caused by the Respondents;

(g) interim and ex parte orders under Section 23 in terms of prayers (a) to (e) during the pendency of this application; and

(h) any other order that this Hon'ble Court considers just and proper.

[SIGNATURE]
Aggrieved Person / Applicant
[NAME]

Through Counsel:
[ADVOCATE'S NAME], Enrolment No. [NUMBER]
[CHAMBER ADDRESS] | [MOBILE NUMBER]

Place: [PLACE]
Date: [DATE]

VERIFICATION

Verified at [PLACE] on [DATE] that the contents of paragraphs 1 to 11 above are true and correct to my knowledge and belief, and nothing material has been concealed.

[SIGNATURE]
Aggrieved Person / Applicant

How to fill it in

  1. Name the right respondentsInclude every person who committed or helped commit the violence and who shared the household with you — the husband and, where their role is specific, in-laws. Courts dismiss vague allegations against distant relatives, so name a relative only if you describe what that person did.
  2. Describe each incident with datesIn paragraph 4, give each incident under the right head (physical, sexual, verbal and emotional, economic, dowry), with the date or approximate period, the place, the person responsible and any witness or medical record. Specific facts carry more weight than general words like 'harassed'.
  3. Identify the shared householdGive the full address and who owns or rents it. Under Section 17, a woman has a right to reside in the shared household whether or not she has any title in it, and in Satish Chander Ahuja v. Sneha Ahuja (2020) the Supreme Court held that this can include a house owned by the in-laws.
  4. Contact the Protection OfficerThe Protection Officer for your district can prepare a Domestic Incident Report (Form I) and help with filing, shelter and medical aid. The Magistrate must take any Domestic Incident Report into account, but you can file directly without one.
  5. Choose your reliefs carefullyAsk only for the reliefs you need. Give a specific monthly amount for maintenance and a figure for compensation, supported by the income and expense details in paragraph 8.
  6. Ask for interim orders with an affidavitFor urgent protection or residence orders, file an affidavit under Section 23(2) (Form III of the Rules) with the application. The Magistrate can pass interim and even ex parte orders on that affidavit.
  7. File and serveFile in the Magistrate's court where you live or where the violence happened. Notice is served on the respondents through the Protection Officer or the police, and the first hearing is ordinarily fixed within three days.

Documents to attach

  • Proof of marriage or relationship (marriage certificate, photographs)
  • Proof of residence in the shared household (Aadhaar, ration card, letters at that address)
  • Medical records and photographs of injuries, if any
  • Copies of police complaints, FIR or women's cell complaints
  • Domestic Incident Report, if prepared by the Protection Officer
  • Screenshots or printouts of messages, emails and call recordings showing threats or demands, with the certificate needed for electronic records
  • List of stridhan, jewellery and articles with any bills or photographs
  • Proof of the respondent's income, if available, and the applicant's expense records
  • Affidavit under Section 23(2) for interim relief, and the Rajnesh v. Neha affidavit of assets and liabilities if maintenance is claimed
  • Vakalatnama, if filing through an advocate

After filing

The Magistrate issues notice to the respondents and may refer the parties to counselling under Section 14. Interim orders can be passed at the first hearing. Final orders can be appealed to the Court of Session within thirty days under Section 29. Breach of a protection order, including an interim one, is a separate offence under Section 31 of the Act, punishable with imprisonment up to one year, fine up to Rs. 20,000, or both; report any breach to the police or the Magistrate.

Common mistakes

  • Making general allegations against every relative of the husband without describing what each one did.
  • Not stating the address and ownership of the shared household, which makes a residence order hard to obtain.
  • Seeking maintenance without disclosing maintenance already awarded in another case.
  • Forgetting the Section 23 affidavit when asking for urgent interim orders.
  • Not listing stridhan items specifically, so the order for their return cannot be enforced.
  • Ignoring a violation of a protection order instead of reporting it under Section 31.

Frequently asked questions

Who can file a domestic violence case?
Any woman who is or has been in a domestic relationship with the respondent and has faced domestic violence — a wife, a woman in a relationship in the nature of marriage, a mother, sister, daughter or widow living in a joint family. A Protection Officer or any other person can also file on her behalf.
Is there a time limit for filing a DV application?
No limitation period applies to a Section 12 application. In Kamatchi v. Lakshmi Narayanan (2022), the Supreme Court held that limitation applies only to prosecution for breach of a protection order under Section 31, not to the application itself. Long delay can still weaken the facts, so file promptly.
Can a woman claim the right to live in her in-laws' house?
Yes, if it was a shared household where she lived in a domestic relationship. In Satish Chander Ahuja v. Sneha Ahuja (2020), the Supreme Court held that a shared household is not limited to a house owned or rented by the husband. The court balances her right with the rights of the owners.
Can women relatives be made respondents?
Yes. In Hiral P. Harsora v. Kusum Narottamdas Harsora (2016), the Supreme Court struck down the words 'adult male' in the definition of respondent, so a mother-in-law or sister-in-law can be a respondent if she committed or helped commit the violence.
Is the DV Act the same as a 498A complaint?
No. The DV Act gives civil reliefs such as protection, residence and maintenance through the Magistrate. Cruelty by the husband or his relatives is a criminal offence under Sections 85 and 86 BNS [Section 498A IPC], prosecuted through an FIR. The two can run side by side.
Can a divorced woman file a DV case?
A woman who has lived in a domestic relationship in the past can file. Courts have allowed applications for acts committed during the marriage, but relief after divorce depends on the facts; take legal advice in such cases.

Reminder: This is a sample format for general information. It is not legal advice and does not create a lawyer–client relationship. Facts, court practice, court fees and stamp duty differ by state and by case. Check the current law and your local court rules, or speak to an advocate, before you file, send or sign it. Spotted an error? Tell us.