Format of Application u/s 12 of Domestic Violence Act 2005

Misc case No
Jurisdiction under Act no 43 of 2005

Application to the Magistrate u/s 12 of the Protection of Women from Domestic Violence Act 2005 and Rule 6(1)- From no II of DV Rule 2006

1. Smt Dipa Sengupta(Dey) Hindu-24
W/o Sree Snehasish Day
R/O 4 No Ichalabad Road, Burdwan-3

                                             ……… ……APPLICANT/COMPLAINANT


1. Smt Reba Dey (Mother- In- Law)
W/O Sree Debasis Dey

2. Sree Debasis Dey (Father – In- Law)
S/O Nepal Ch Dey
Both Reside at
R/O 4 Ichalabad
Srepally Post


Most respectfully Showeth

1. That the Applicant is the daughter –in-law of the Respondents and she married their younger son Sree Snehasish Day on through an arrange marriage, is here aggrieved before your honour and praying for sole relief u/s 19 of the Act no 43 of 2005 along with the Rules framed their under. The Applicant is mother of a baby child aged . The Applicant is a qualified graduate and earn her living by giving tuition from the above residence. Presently due to COVID-19 situation she and her husband facing severe hardship, mentally and financially. Above this the Respondents specially the Respondent no 1(Mother –in-Law) is abusive in nature and verbally and emotionally torture the Applicant by insulting, ridiculing, humiliating ,name calling and defame her in locality and severely ridicule her for being fatty. She tries to create difference between the Applicant and her husband. The respondent no 2(Father-In-Law) is alcoholic in nature and encourage Respondent no 1 to do above things. He enjoys a psychic temper when the mother –in- law creates violence to the Applicant. She may instigate to the Applicant to jump from the Varanda or do suicide or to get out of the house in presence of Applicant`s husband or in his absence.
2. That on 29th July 2020 Wednesday afternoon, the mother- in- law all on a sudden started quarreling with the applicant and started to push her out of the house and ordered to get out of the house immediately. The applicant call her husband from his work place and all the society people gathered near the house to inquire about the incidence. The respondent no 1 had a singular claim that the house belongs to her, as her husband gifted it to her and she would not allow the applicant to reside in the house. Everybody said that the house actually belongs to the Respondents` late mother and as a joint family everybody live in the three storied building , occupying their respective rooms. The Applicant with her husband, and baby child live in her single separate room. The elder son of the Respondents lives in a separate room in the second floor and the Respondents live in their separate room in the same first floor and share kitchen with the Applicant.

3. That the Respond no 1 may coerce with the Applicant in front of her students and humiliate her for doing tuition at the residence(room). The Applicant is the single daughter of her parents. Her father died when she was young and her mother somehow manages her education by taking help from relatives. After her marriage she tried her best to cope with the situation in in-laws house. Her husband loves her and they had initially no problem to live in the joint family with their one year old baby child. But the Respondent no 1 gradually cultured a strange animosity and bitterness with the Applicant and became violent to her. The respondent may bring some unknown men to the house in absence of her husband and they may peep to the room of the of the applicant. The applicant and her husband along with other family members cautioned her not to bring outsider or unknown people to the house but she never listened it. The Respondent no 2 being an alcoholic never control the situation rather he enjoyed it. Their grandfather Shree Gopal ch Day is still alive and cautioned the respondents to behave properly. but they never care it. Now the respondent no 1 concluded that due to the Applicant and his husband( the younger son) he free style life has been jeopardized, therefore she become violent to the Applicant. The applicant has no protection.

4. That the Respondent no 1, since July 2020 as mentioned above continuously threat the applicant to oust her in absence of her husband or even in front of her husband that she may file false cases against her to police and she has relation with several police in local Thana. The house in question actually belongs to the late wife of Gopal Chandra (grandmother) and they live there as her successor in their respective Rooms under the same roof of the shared household. At the time of marriage negotiation, it was understood and said that after marriage the Applicant and the respondents shall live together in their separate rooms(matrimonial house) and the things was going on as of now. Now the Respondent no 1 wants to evict the applicant and disturbed her tuition classes without any reason. Therefore under severe threat the Applicant has no other alternative, than to pray for protection.

5. That in face of severe threat and humiliation the applicant and her husband habe no option in the Covid-19 situation, that they may go elsewhere in a tenanted house with their baby child. Then why should they compromise there accommodation to adjust the wild fancy of the Respondent no 1. The Applicant has been applying utmost restraint to disclose the nature of her mother–in-law. Her only request before your honour that she may not be evicted from the present residential house and particularly from her Room in the first floor of the three storied building situated at 4 No Botanical Garden, under AJC Bose Police station mentioned in the schedule.

It is therefore humbly prayed that your honour may graciously be pleased to pass the following order/s under DV Act 2005 in favour of the Applicant and against the Respondents

a. Right to reside in the Shared Household in the scheduled residence u/s17(1)(2)
b. Protection order u/s 18(a -g)
c. Residence Order u/s 19(1-7)
d. Interim order in terms of prayer (a)(b )and (c)
e. Ad- interim order in terms of Prayer no (c)
f. Treat this application as high emergency and extremely urgent
g. Any other order/s

And for this act of grace your petitioner shall be duty bound and shall ever pray



I Smt Dipa Sengupta(Dey) do hereby verify this Application u/s 12 of the Domestic Violence Act 2005 at the Howrah Dist Court premises of the ………………. and state that the para no 1 to 5 of the application are correct to the best of my knowledge and nothing material concealed thereform.



I Smt Dipa Sengupta(Dey), W/O Snehasish Dey , by faith Sanatan Hindu Dharmin, aged 24, Graduate, Residing at 4 No 4no Ichalabad Burdwan-3, by profession private teacher, do here by solemnly affirm that I verified the above Application and it was drafted as per my instruction . I am acquainted with the facts and circumstances of the case and I am competent to do so. Solemnly affirming on the ………………………………………….




A separate room with shared and common kitchen at the first floor of a three storied building , situated at 4 no Ichhalabad Road Road ,Burdwan -3.

Deponent Identified by me


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