PETITION FOR RESTITUTION OF CONJUGAL RIGHTS
IN THE DISTRICT COURT AT....................
........................................................................ Petitioner
versus 
..................................................................... Respondent
Petition for the restitution of conjugal rights under Section 22 of the Special Marriage Act, 1954 (No. 43 of 1954).
The petitioner prays as follows: —
1. The petitioner is the husband/wife of the respondent. The marriage between the parties was solemnized/registered under Chapter Il/Chapter III of the Act by the Marriage Officer of.................... at.................... on.................... A certified copy of the certificate of marriage is attached with this petition.
2. The status and place of residence of the parties to the marriage before the marriage and at the 
Husband									Wife
Status										Status
Age										Age
Place of Residence								Place of Residence

(i) Before marriage
(ii) At the time of filing the petition

3. (In this paragraph state the names of the children, if any, of the marriage together with their sex, dates of birth or ages).
4. The respondent has, without reasonable excuse, withdrawn from the society of the petitioner with effect from....................
(The circumstances under which the respondent withdrew from the society of the petitioner be stated).
5. There has not been any unnecessary or improper delay in filing this petition.
6. The petition is not presented in collusion with the respondent.
7. There is no other legal ground why the relief should not be granted.
8. There has not been any previous proceedings with regard to the marriage by or on behalf of the parties.
There have been the following previous proceedings with regard to the marriage by or on behalf of the parties: —
Serial No.	Name of Parties	Name of Proceedings with section of the Act	Number and date and year of the case	Name and location of the court	Result
	
(i)						
(ii)						
(iii)						
(iv)						

9. The marriage was solemnized at.......................................:...
The parties last resided together at..........................................
The Parties are now residing at.........................................
(within the local limits of the ordinary original jurisdiction of this Court).
10. The petitioner submits that this Hon’ble Court has jurisdiction to entertain this petition.
11. The petitioner, therefore, prays for a decree for restitution of conjugal rights against the respondent.
Petitioner 
VERIFICATION
The abovenamed petitioner states on solemn affirmation that Paras................. to.................... of the petition are true to the petitioner’s knowledge and paras .................... to.................... are true to the petitioner’s information received and believed to be true by him/her.
Verified on this................. day of.................... 19.................... at....................
Place.................... Petitioner