Pro Se 1

Complaint for a Civil Case

Agency
U.S. Courts
Revision
Rev. 12/16
Fillable fields
76
Pages
5
Official source
U.S. Courts form page
Checked
October 20, 2026
Fill Pro Se 1 online
Page 1 of form Pro Se 1

Pro Se 1: Complaint for a Civil Case

Pro Se 1, Complaint for a Civil Case, is a pleading form from the U.S. Courts for a civil case in a United States district court. It is one of the Civil Pro Se Forms, which the U.S. Courts page says are limited to types of cases often filed in federal courts by people who represent themselves or who may not have much experience in federal courts.

The form asks for the parties, the basis for federal court jurisdiction, a short and plain statement of the claim, the relief requested, and a signed certification under Federal Rule of Civil Procedure 11. The page notes that no form provides legal advice or substitutes for having or consulting a lawyer, and that a court may require more or less information than a form asks for.

The U.S. Courts offers it as a PDF and a Word file, effective on December 1, 2016. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of Pro Se 1: Complaint for a Civil Case, as printed by COURTS

What's on Pro Se 1

Caption

The district and division, the full name of each plaintiff and defendant, a yes or no choice for a jury trial, and a case number left for the Clerk's Office. Names that do not fit go on an attached page, with "see attached" written in the space.

I. The Parties

Name, address, phone and email for each plaintiff, and for each defendant, whether an individual, government agency, organization or corporation, with an individual's job or title if known. There is room for four defendants.

II. Basis for Jurisdiction

Federal question, diversity of citizenship or both. A federal question case lists the statutes, treaties or constitutional provisions at issue. A diversity case gives each party's citizenship or place of incorporation and explains the amount in controversy.

III. Statement of Claim

A short and plain statement of facts, without legal arguments: how each defendant was involved, what each did, and the dates and places. Several claims are numbered in separate paragraphs.

IV. Relief

The damages or other relief asked for, any basis for saying the wrongs are continuing, the amounts of actual damages and their basis, and any punitive or exemplary damages with amounts and reasons.

V. Certification and Closing

A certification under Federal Rule of Civil Procedure 11, then the date, signature and printed name of the plaintiff, or the attorney's details.

How to fill out Pro Se 1

  1. 1

    Read the notes on the form page

    The U.S. Courts page says no form provides legal advice, a court may require more or less than a form asks, and to consult the rules and caselaw that govern in the court where you file.

  2. 2

    Fill in the caption and parties

    Enter the district, division and the full names of the parties, choose yes or no for a jury trial, and leave the case number for the Clerk's Office.

  3. 3

    Mark the basis for jurisdiction

    Check federal question, diversity of citizenship or both, and fill out only the paragraphs in section II that apply.

  4. 4

    Write the claim and the relief

    The form asks for short and plain statements, without legal arguments, in sections III and IV. Attach pages if needed.

  5. 5

    Leave out private details

    The page cites Federal Rule of Civil Procedure 5.2: a filing may show only the last four digits of a Social Security, taxpayer or financial account number, the year of birth, and a minor's initials.

  6. 6

    Sign and date

    Sign under the Rule 11 certification and print your name. Parties without an attorney also agree to keep their address current with the Clerk's Office.

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Court, timing and help

Court

The form is captioned for a United States District Court, district and division. The page says to consult the rules and caselaw that govern in the court where the pleading is filed.

Fees

The form and its page do not list filing fees; the court sets them. The U.S. Courts forms list includes AO 240 and AO 239, applications to proceed in district court without prepaying fees or costs.

Timing

The page says the forms give no guidance on when pleadings, claims or defenses have to be raised or who has to be sued, and that some have to be raised within a certain period of time.

A lawyer

The page says that if you are not a lawyer and are suing or have been sued, it is best to have or consult a lawyer if possible.

Formats

The U.S. Courts page offers Pro Se 1 as a PDF and as a Word document.

Who uses Pro Se 1?

  • People representing themselves

    Section V.A is for parties without an attorney. They agree to tell the Clerk's Office about any address change, and the form says a missing current address may result in dismissal of the case.

  • Plaintiffs in a federal question case

    The form describes these as cases arising under the United States Constitution or federal laws or treaties, under 28 U.S.C. § 1331.

  • Plaintiffs in a diversity of citizenship case

    The form describes these as cases where a citizen of one State sues a citizen of another State or nation and the amount at stake is more than $75,000, under 28 U.S.C. § 1332, with no defendant a citizen of the same State as any plaintiff.

  • Attorneys

    Section V.B has a signature block for an attorney, with bar number, law firm, address, phone and email.

The page describes the Civil Pro Se Forms as examples for people who represent themselves or have little experience in federal courts, and says to use the form that fits your case.

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Questions about Form Pro Se 1

Is Pro Se 1 legal advice?

No. The U.S. Courts page says no form provides legal advice or substitutes for having or consulting a lawyer, and that following a form does not guarantee a pleading is legally or factually correct or sufficient.

Is Pro Se 1 the right form for my case?

This page cannot say. The U.S. Courts page says some forms, such as the generic complaint, apply to different types of cases and others only to specific types, and to use the form that fits your case. The forms list also has case-specific complaints, such as Pro Se 7 for employment discrimination. The page says it is best to have or consult a lawyer if possible.

Who fills in the case number?

The form says the case number is filled in by the Clerk's Office.

What personal details does a complaint leave out?

The page cites Federal Rule of Civil Procedure 5.2: filings should not contain anyone's full Social Security number or full birth date, the name of a person known to be a minor, or a complete financial account number.

What if there are more than four defendants?

Write "see attached" in the caption and attach a page with the full list of names. Section I says to attach additional pages if needed.

What does the $75,000 on the form refer to?

The form says a diversity of citizenship case is one where a citizen of one State sues a citizen of another State or nation and the amount at stake is more than $75,000, not counting interest and costs of court. Section II.B.3 asks the plaintiff to explain the amount.

Does Pro Se 1 say when to file?

No. The page says the forms give no guidance on timing, that some pleadings, claims or defenses have to be raised within a certain period of time, and that the Federal Rules of Civil Procedure are available free at www.uscourts.gov.