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(Name, Address Of Party or attorney)
_____________________________
_____________________________
_____________________________
State Bar No: __________________
(____) _____ - _________________
Attorney for _______ (Or "In Pro Per")
SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF ________
PLAINTIFF(S) NAMES ) CASE NO.: _______
Plaintiffs )
)
v )
)
DEFENDANT(S) NAMES )
Defendants )
)
---------------------------------------------------------
COMPLAINT FOR INTENTIONAL AND NEGLIGENT EMOTIONAL DISTRESS
Plaintiff complains and for causes of action alleges as follows:
FIRST C AUSE OF ACTION
(Intentional Infliction of Emotional Distress against ___)
I.
Defendant __, ___ is __, and at all times herein mentioned was __, a resident__ of the City
of ___, County of __, State of California.
II.
Defendant __, ___, is __, and at all ti mes herein mentioned, was__ a Corporation
organized and existing under the laws of the State of California with principle offices located at
___, in the City of ___, County of ___.
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III.
Plaintiff__ is__ ignorant of the true names and capacities of defendants sued herein as
DOES I through X, inclusive, and therefore sues__ these defendants by such fictitious names.
Plaintiff__ will amend this complaint to allege their true names and capaci ties when ascertained.
IV.
Plaintiff__ is__ informed and believes__ and thereon alleges__ that, at all times herein
mentioned, each of the defendants sued herein was the agent and employee of each of the
remaining defendants and was at all times acting wi thin the purpose and scope of such agency and
employment.
V.
___ _[--- Allege facts showing relationship of parties giving rise to defendant's duty to
exercise due care towards plaintiff or, if action arises out of defendant's breach of contract with
plaint iff, allege execution and relevant terms of contract ---- ]
VI.
___ [--- Allege defendant's act or omission to act constituting breach of duty or breach of
contract --- ]
VII.
___ [--- Allege intent to cause emotional distress, e.g., Defendant ___'s conduct was
intentional and malicious and done for the purpose of causing Plaintiff to suffer humiliation,
mental anguish, and emotional and physical distress. ---- ]
VIII.
As a proximate result of defendant's ____[ --- act or omission --- ], ___[ --- specify
consequences of breach support claim ---- ].
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IX.
As a further proximate result of defendant____ ____[ --- specify act --- ] and the
consequences proximately caused by it, as here in above alleged , plaintiff suffered severe
humiliation, mental anguish, and emotional and p hysical distress, and has been injured in mind
and body as follows: _____, all to ___ damage in the sum of $_____.
X.
[--- Continue, alleging in this and subsequent paragraphs each item of special damages, if
any, suffered by plaintiff, including any loss of wages and medical and related expenses incurred
or paid. ---- ]
FIRST CAUSE OF ACTION
(Negligent Infliction of Emotional Distress against ___)
XI.
____[ --- Allege facts showing relationship of parties giving rise to defendant's duty to
exercise due care towards plaintiff or, if action arises out of defendant's breach of contract with
plaintiff, allege execution and relevant terms of contract ---- ]
XI I.
Defendant___ knew, or should have known, that ___ failure to exercise due care in the
performance of ____[ --- act to be done or terms of the contract --- ] would cause plaintiff___ severe
emotional distress.
XIII.
___[ --- Allege defendant's act or omissi on to act constituting breach of duty or breach of
contract --- ]
XIV.
As a proximate result of defendant's ____[ --- act or omission --- ], ___[ --- specify
consequences of breach support claim ---- ].
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XV.
As a further proximate result of defendant____ ____[ --- sp ecify act --- ] and the
consequences proximately caused by it, as here in above alleged , plaintiff suffered severe
emotional distress and mental suffering, all to ___ damage in the sum of $_____.
XVI.
[--- Continue, alleging in this and subsequent paragraph s each item of special damages, if
any, suffered by plaintiff, including any loss of wages and medical and related expenses incurred
or paid. ---- ]
WHEREFORE, plaintiff prays judgment against defendant as follows:
For general damages for severe emotional distress and mental suffering in the sum of
$_____;
[--- For medical and related expenses in the sum of $____[ --- or according to proof --- ];
[--- For lost wages in the sum of $____ --- ];
[--- For _____ --- ]
For costs of suit herein incurred; and
For such other and further relief as the court may deem proper.
DATE: ____________________
____________________
(Signature)
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VERIFICATION
I, ___, am a ___in the above -entitled action. I have read the foregoing ___and know the
contents thereof. The same is true of my own knowledge, except as to those matters which are
therein alleged on information and belief, and as to those matters, I believe it to be true.
I declare under penalty of perjury that the foregoing is true and correct and that this
declaration was executed at , California.
DATE: ____________________
____________________
(Signature)