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CIV-050Mandatory

Statement of Damages (Personal Injury or Wrongful Death)

California · Judicial Council of California · Effective July 1, 2025

This form is used to list the maximum amount of money a person is asking for in a personal injury or wrongful death case. It breaks down the requested money into different types of damages, such as pain, medical bills, and lost wages.

The court describes it as: Tells the other side the maximum amount of damages you are seeking in a personal injury or wrongful death case. It is not filed with the court except when the defendant defaults.

Open the official PDFfrom Judicial Council of California

Where this fits in a case

Motions

Stage: Motions

This form is used in a civil case involving personal injury or wrongful death. It is not filed with the court unless the defendant fails to show up in court.

Usually filed by the person starting the case.

Common questions

Who fills out this form?
The plaintiff or the plaintiff's attorney fills out this form to tell the other side the damages being sought.
Does this form need to be filed with the court?
No, the form text states it should not be filed with the court unless you are applying for a default judgment.
What does the second page of the form do?
The second page is a Proof of Service, which is used to show that the other party was properly given copies of the Statement of Damages.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect July 1, 2025.

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