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Bare acts > Protection of Women from Domestic Violence Rules, 2005 > Form II
 
  


 

SCHEDULE - I

FORM NO. II

Petition/Application to the Magistrate under Section 9 (1) read with Section 12 of the Act and Section 37 (2) (d), (e) and (h) of the Act.

To

The Learned Magistrate

……………………………...

……………………………...

Application under the ………….Act SHEWETH:

1. That the application under Section………of ………Act is being filed along with copy of (Domestic Incident Report) by the:-

a) Aggrieved person ….

b) Protection Officer ….

c) Any 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 & pass all/any of the orders, as deemed fit, in the circumstances of the case.

(a) Pass protection orders under Section 18 of the Act and/or

(b) Pass residence orders under Section 19 of the Act and/or

(c) Direct the respondent to pay monetary relief under Section 20 of the Act and /or

(d) Pass orders under Section 21 of the Act and/or

(e) Direct the respondent to grant compensation/damages under Section 22 of the Act 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;

(Signature)

Aggrieved person

Protection Officer

 

 

 

 

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