Certification Of Proof - Superior Court Of New Jersey Page 5
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6Civil – SCP - Default Judgment
Instructions for Completing the Certification of Proof (Form A)
1. At the top left of the form, enter your name, address, and daytime phone number. If you are not an
attorney, leave the Attorney ID field blank.
2. On the line labeled Plaintiff(s), type or print the plaintiff’s name.
3. On the line labeled Defendant(s), enter the name(s) of the defendants listed on the complaint.
4. On the line labeled County, enter the county where you are filing this case.
5. On the line labeled Docket Number, enter the docket number. This information can be found on the
post card that you received in the mail from the court.
6. To the right of item 1, enter the name of the person who has personal knowledge and is swearing to
the facts of the case.
7. For items 2 and 3, no information required. This is a statement, which you are certifying by your
signature to be true.
8. In the space after item 4, enter the address of the defendant/judgment debtor. You are also required
to specify how you have personal knowledge that this is the defendant’s address,
9. Only complete Item 5 if the default judgment is against an individual, if defendant/judgment debtor
is a business, SKIP THIS ITEM. For a default judgment against an individual, select the
appropriate checkbox (
is
is not on active duty). On the lines below that statement, list all facts
and explain how you know that the defendant is, or is not, in the active military service; or, attach
the statement received from the Defense Manpower Data Center. If you contacted the five branches
of the military directly, attach a copy of the statement you received from each branch.
10. Enter the specific dollar amount for the default judgment requested, in item 6 after the text that reads
owes the total amount of.
• For item 6a list he principal amount due: the initial amount of money that was paid, invested,
borrowed, loaned, etc., plus, any interest (where applicable). If you are requesting interest,
you will be required to provide documentation that provides for the rate of the interest.
• For item 6b, enter the court costs (filing fees paid by the plaintiff) to date. If you do not
know the total of the filing fees you have paid, the Office of the Special Civil Part can
provide this information.
11. For item 7, no information required. This is a statement, which you are certifying by your signature
to be true.
12. Date and sign the form, and print your name under the signature. Note: when you fill out this form,
you are certifying that the statements made on the form are true. If you willfully make false
statements, you may be subject to punishment.
Revised 04/18/2017, CN 10914 (How to Request a Default Judgment)
page 5 of 6
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