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New Jersey Judiciary Civil Practice Division
Civil Case Information Statement (CIS)
Use for initial Law Division Civil Part pleadings (not motions) under Rule 4:5- 1. Pleading will be rejected for filing, under Rule 1:5-6(c), if information above the black bar is not completed, or attorney’s signature is not affixed.
For Use by Clerk’s Office Only
Payment type ☐^ check^ Charge/Check Number Amount Overpayment Batch Number ☐ charge $ $ ☐ cash
Attorney/Pro Se Name Telephone Number County of Venue
Firm Name (if applicable) Docket Number (when available)
Office Address - Street City State Zip
Document Type Jury Demand
☐ Yes ☐ No
Name of Party (e.g., John Doe, Plaintiff) Caption
Case Type Number (See page 3 for listing)
Are sexual abuse claims alleged? (^) ☐ Yes ☐ No
Does this case involve claims related to COVID-19? (^) ☐ Yes ☐ No
Is this a professional malpractice case? (^) ☐ Yes ☐ No
If “Yes,” see N.J.S.A. 2A:53A-27 and applicable case law regarding your obligation to file an affidavit of merit.
Related Cases Pending? (^) ☐ Yes ☐ No
If “Yes,” list docket numbers
Do you anticipate adding any parties (arising out of same transaction or occurrence)?
☐ Yes ☐ No
Name of defendant’s primary insurance company (if known) (^) ☐ None ☐ Unknown
The Information Provided on This Form Cannot be Introduced into Evidence.
Case Characteristics for Purposes of Determining if Case is Appropriate for Mediation
Do parties have a current, past or recurrent relationship? (^) ☐ Yes ☐ No
If “Yes,” is that relationship: ☐ Employer/Employee ☐ Friend/Neighbor ☐ Familial ☐ Business ☐ Other (explain)
Does the statute governing this case provide for payment of fees by the losing party?
☐ Yes ☐ No
Use this space to alert the court to any special case characteristics that may warrant individual management or accelerated disposition.
Do you or your client need any disability accommodations? ☐^ Yes^ ☐^ No If yes, please identify the requested accommodation:
Will an interpreter be needed? ☐^ Yes^ ☐^ No If yes, for what language?
I certify that confidential personal identifiers have been redacted from documents now submitted to the court and will be redacted from all documents submitted in the future in accordance with Rule 1:38-7(b).
Attorney/Self-Represented Litigant Signature:
Track IV - Active Case Management by Individual Judge / 450 days discovery 156 Environmental/Environmental Coverage Litigation 303 Mt. Laurel 508 Complex Commercial 513 Complex Construction 514 Insurance Fraud 620 False Claims Act 701 Actions in Lieu of Prerogative Writs
Multicounty Litigation (Track IV) 271 Accutane/Isotretinoin 281 Bristol-Myers Squibb Environmental 282 Fosamax 285 Stryker Trident Hip Implants 291 Pelvic Mesh/Gynecare 292 Pelvic Mesh/Bard 293 DePuy ASR Hip Implant Litigation 296 Stryker Rejuvenate/ABG II Modular Hip Stem Components 299 Olmesartan Medoxomil Medications/Benicar 300 Talc-Based Body Powders 601 Asbestos 624 Stryker LFIT CoCr V40 Femoral Heads 625 Firefighter Hearing Loss Litigation 626 Abilify 627 Physiomesh Flexible Composite Mesh 628 Taxotere/Docetaxel 629 Zostavax 630 Proceed Mesh/Patch 631 Proton-Pump Inhibitors 632 HealthPlus Surgery Center 633 Prolene Hernia System Mesh 634 Allergan Biocell Textured Breast Implants 635 Tasigna 636 Strattice Hernia Mesh 637 Singulair 638 Elmiron
If you believe this case requires a track other than that provided above, please indicate the reason on page 1, in the space under “Case Characteristics”.
Please check off each applicable category
☐ Putative Class Action ☐ Title 59 ☐ Consumer Fraud
