Petition for Judicial Separation
In the Court of……….at…………..
Matrimonial Jurisdiction
                                                            In the matter of s. 10 of the Hindu
                                                            Marriage Act 1955, and in the matter of:
                                                                                                           AB…………………… Petitioner
                                                                                                       versus
                                                                                CD…………………….Respondent
                                                                  The humble petition of…….of….
                                                                                                      No …………(full name and address)

Most Respectfully Sheweth:
1. That at all material times and at present the parties to the proceedings were and are Hindu and so governed by the Hindu Marriage Act 1955.
2. That on the ………. day of……….. the applicant was duly married to CD at…………..and the said marriage was solemnised according to Hindu rites. (An extract from the Marriage Registrar or an affidavit duly attested to be filed).
3. That the following are the issues of the said marriage (name, date of birth, age and sex).
4. That ever since the said marriage and until the……….day of………..the applicant and the said CD lived and cohabited as husband and wife at etc……when he withdrew himself from the society of the applicant without any reasonable or probable cause and thereby deserted her to all intents and purposes.
5. That from and shortly after the marriage the said CD habitually and with very few exceptions conducted himself towards the applicant with severe harshness and cruelty and at times abused her in most filthy language (state particulars of cruelty).
6. That the applicant has not in any manner been accessory to or connived at or condoned any of the said acts of CD.
7. That the said CD further falsely, maliciously charged the applicant as having committed adultery, abused the applicant in various ways and treated the applicant with such cruelty as to cause a reasonable apprehension in the mind of the applicant that it will be most harmful or injurious for the petitioner to live further with the said CD.
8. That there were no previous proceedings between the parties and there is no collusion between the applicant and CD with respect to the subject-matter of the present petition.
9. That the applicant has come to court with the greatest promptitude and least delay (in case of delay the same must be explained).
10. That this court has jurisdiction to entertain this application as the marriage was celebrated at (the parties reside or last resided within the jurisdiction of this court).
The applicant therefore prays for a decree for judicial separation between the applicant and the said CD.
Signed                                                                                                          AB
Verification
I, AB, daughter of XY and wife of CB aged about ……..years by occupation service residing at…………………..do hereby solemnly affirm and say as follows:
I am the petitioner above-named and I know and I have made myself acquainted with the facts and circumstances of this case.
The statements in paragraphs 1 to 10 are true to my knowledge and belief.
I sign this verification on this…………day of…………………at the Court
House at……………
Signature of AB
Before me                                                                        Signature of Advocate
Notary