California Court Forms · Civil

CIV-050: Statement of Damages (Personal Injury or Wrongful Death)

The notice of the damages a plaintiff seeks in a personal injury or wrongful death case, with a proof of service on page 2.

Mandatory form · Revised July 1, 2025 · 2 pages · A PLD-PI-001 or other injury complaint

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The PDF is the Judicial Council’s own file on courts.ca.gov, revised July 1, 2025. Form page on courts.ca.gov ↗

Not legal advice. This page explains what the form asks; it does not tell you what to put in your case.

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What it is

Served, and usually not filed

The top of CIV-050 says: do not file with the court unless you are applying for a default judgment under Code of Civil Procedure section 585. It is addressed to one defendant from one plaintiff and lists the damages sought. It cites Code of Civil Procedure sections 425.11 and 425.115.

When it is used

Damages by category

Page 1 lists general damages, special damages and the punitive damages the plaintiff reserves the right to seek. Page 2 is a proof of service completed by the person who served it; the form says the plaintiff cannot serve these papers.

Section by section

What each part asks

Use the current official form and its instructions. The descriptions below identify the questions without choosing answers for your situation.

Page 1 · The statement

To and from: One defendant and one plaintiff, by name.
1 · General damages: Pain and suffering, emotional distress, loss of consortium, loss of society (wrongful death only) and other.
2 · Special damages: Medical expenses, earnings and earning capacity, property damage, and wrongful death items such as funeral expenses.
3 · Punitive damages: The amount the plaintiff reserves the right to seek, then date and signature.

Page 2 · Proof of service

1–2 · What, who and how: The papers served, the person served, and the manner: personal, substituted, mail and acknowledgment, certified mail outside California or other.
3–5 · The server: At least 18 and not a party, the fee, and whether the server is a sheriff, registered process server or other, with a signature.

Before you file

Common filing problems to check

These checks come from the official form and instructions. They are not a ranking of rejection reasons; the court decides whether a filing meets its requirements.

CIV-050 is filed with the court when no default judgment is being requested, against the instruction at the top of the form.
More than one defendant or plaintiff is named on one statement; the form provides for one of each.
The plaintiff completes the proof of service; the form says the plaintiff cannot serve these papers.
Substituted service is checked without the declaration of reasonable diligence the form says to attach.

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How to e-file CIV-050 with Legal Hub Group

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Live counties with a relevant case type: Butte · Calaveras · Colusa · Contra Costa · Glenn · Los Angeles · Madera · Mariposa · Mendocino · Merced · Napa · San Bernardino · San Diego · San Luis Obispo · San Mateo · Santa Barbara · Santa Clara · Santa Cruz · Sonoma · Stanislaus · Sutter · Tehama · Yolo · Yuba. Check each listing’s new-case or existing-case status and document restrictions.

Questions

CIV-050 questions

Do I file CIV-050 with my complaint?

No. The form says not to file it with the court unless you are applying for a default judgment under Code of Civil Procedure section 585.

Who completes page 2?

The person who served the statement. The form says the plaintiff cannot serve these papers.

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Guides & comparisons

Not legal advice. This page explains public filing information. It does not tell you what to put in your own case. Legal Hub Group is a certified e-filing service provider for California courts, not a law firm.

Information checked as of October 2026. Rules, form revisions and provider prices can change. The court decides whether to accept a filing.

CIV-050 form revision: July 1, 2025.