General Civil Case Cover Sheet

STATE OF SOUTH CAROLINA IN THE COURT OF COMMON PLEAS
[COUNTY] COUNTY Civil Action No. ___________________

[PLAINTIFF NAME(S)],
Plaintiff(s),

v.

[DEFENDANT NAME(S)],
Defendant(s).

GENERAL CIVIL CASE COVER SHEET

Effective Date of Filing: _______________________

1. ATTORNEY / PARTY INFORMATION

2. NATURE OF ACTION (CHECK ONE BOX ONLY)

A. Tort – Non-Insurance
☐ T110 Motor Vehicle Accident
☐ T120 Personal Injury (non-MV)
☐ T130 Medical Malpractice
☐ T140 Premises Liability
☐ T150 Products Liability
☐ T160 Wrongful Death
☐ T170 Assault & Battery
☐ T180 Defamation / Libel / Slander
☐ T199 Other Tort (specify): __________________

B. Tort – Insurance (claim includes carrier)
☐ I110 Motor Vehicle Accident
☐ I120 Bad-Faith Denial of Coverage
☐ I130 MedPay / UM / UIM
☐ I199 Other Insurance Tort (specify): _____________

C. Real Property
☐ R210 Condemnation / Eminent Domain
☐ R220 Foreclosure (Primary Residence)
☐ R221 Foreclosure (Commercial / Other)
☐ R230 Partition / Quiet Title
☐ R240 Mechanic’s / Construction Lien
☐ R250 Other Real Property (specify): ______________

D. Contract / Business
☐ C310 Breach of Contract / Warranty
☐ C320 Debt Collection / Promissory Note
☐ C323 Construction Defect
☐ C330 Unfair Trade Practices / SCUTPA
☐ C340 Insurance Coverage / Declaratory J.
☐ C350 Employment Contract / Restrictive Covenant
☐ C399 Other Contract (specify): __________________

E. Other Civil / Special Proceedings
☐ O410 Temporary Restraining Order
☐ O420 Permanent Injunction
☐ O430 Declaratory Judgment (non-insurance)
☐ O440 Administrative Appeal (state agency)
☐ O450 Arbitration Award Confirmation / Vacatur
☐ O499 Other (specify): ___________________________

3. RELIEF SOUGHT

☐ Money Judgment
☐ Equitable / Declaratory Relief
☐ Other: ________________________________________

Amount in Controversy (if monetary): $________________

4. JURY DEMAND

☐ Yes   ☐ No

5. ALTERNATIVE DISPUTE RESOLUTION (ADR) STATUS

Pursuant to Rule 3, South Carolina ADR Rules:
☐ The case is subject to mandatory mediation.
☐ The case is exempt (basis): ________________________________.
☐ The case is subject to binding arbitration by contract/statute.

6. FILING FEE CALCULATION

1. Statutory Complaint Filing Fee (S.C. Code § 8-21-310(11)(a))…… $150.00
2. Motion Filing Fee(s) (if concurrently filed) (S.C. Code § 8-21-310(11)(b))… $25.00 × [ # ] = $_______
3. Other (specify): _________________________________________ … $_______
   Total Enclosed: $___________________

Payment Method: ☐ Check ☐ Money Order ☐ Credit Card (if accepted) ☐ eFiling

7. SERVICE INFORMATION

☐ Service by Sheriff  ☐ Private Process Server  ☐ Acceptance / Waiver  ☐ Certified Mail
Anticipated Service Address(es): _________________________________________________

8. CERTIFICATION & SIGNATURE

I certify that, to the best of my knowledge, this cover sheet is complete and accurate, that the category selected above is the most appropriate for the action being filed, and that all applicable filing fees have been tendered or will be paid contemporaneously with this filing.

[ATTORNEY NAME], SC Bar No. [___]
Attorney for □ Plaintiff □ Defendant Date: _____________________

Signature: __________________________________________

CLERK’S OFFICE USE ONLY

Date Received: ____________________  Initials: ________  Receipt No.: __________
Civil Action Number Assigned: _______________________
ADR Tracking Code: _________  Jury:  Yes / No  Fee Verified:  Yes / No