Revised: 08/2013, CN: 10296 page 1 of 2
Office of Attorney Ethics
Attorney Fee Arbitration Request Form
For Office Use Only
File Number
Date Entered in OAE Database
Filing Fee Paid:
A Non-Refundable Filing Fee check in the amount of $50 must be included payable to “Disciplinary Oversight Committee.”
Please type or clearly print all information: Submit 1 original and 5 copies of all documents submitted, including attachments.
The Specific Attorney Who Handled My Case Is
: (Please list only one attorney here. Please list on a separate sheet the
names and addresses of any other attorney whose fee you challenge as par
t of this fee arbitration proceeding.)
Last Name (include: Sr./Jr./III, etc.)
First Name
Middle Initial
Office Telephone
Client Information:
(Please only list one client name in this section. Please list on a separate sheet the names and address of
any other person who should be listed as the “client” in this fee arbitration proceeding.)
Last Name (include: Mr./Mrs./Miss/Ms.)
First Name
Middle Initial
Home Telephone
Work or Cell Phone Number
The Type of Case Handled By the Attorney Was:
Admiralty/Maritime International Law
Adoption/Name Change
Juvenile Delinquency
Landlord / Tenant
Negligence (Personal Injury Property Damage)
Corporation/Partnership Law
Patent / Trademark / Copyright
Criminal/Quasi-criminal and Municipal Court
Real Estate
Domestic Relations (Divorce, Support, Custody)
Small Claims Court
Federal Remedies / Civil Rights
Workers Compensation
Government Agency Problems (Local Thru Federal)
Other Litigation (specify)
Immigration / Naturalization
Other Non-Litigation (specify)
What was the amount of the attorney’s total bill
(not just the fee charged for attorney time or services in dispute)?
Total Legal Fee Charged (for attorney time) $
+ Total Costs/Disbursements $
= Total Bill $
Amount paid to Attorney $
(attach proof of payment)
Who Paid:
Other (specify name)
Attorney Fee Arbitration Request Form
Revised: 08/2013, CN: 10296 page 2 of 2
Was there a written fee agreement or fee letter from the attorney explaining how much would be charged?
If yes, attach a copy.
1. Had the attorney or law firm ever represented you before accepting this case?
Yes No
2. Was the fee charged by the attorney contingent on the outcome of the case so that there was no fee due
the attorney recovered money for you?
When did the attorney first agree to handle your case?
4. When did the attorney
last do any work on this case?
Did the attorney advise you in writing that you could request fee arbitration?
If yes, attach a copy of that notice or letter, and state the date you received it:
Has the attorney brought a lawsuit or other court action against you for the fee?
Yes No
If yes, attach a copy of the complaint or other court filing and list:
Docket Number:
, County where filed:
Date you were served with the complaint or filing:
List all amounts paid to the attorney and the dates of payment.
Attach copies of all bills received from the attorney and any
Briefly explain why you disagree with the attorney’s total bill. Use additional sheets, if needed.
I further state that, although I have the right to present this matter to a Court in this State, I wish to waive this right and submit my
case to the New Jersey Supreme Court’s District Fee Arbitration Process. I realize that I have 30 days only from the date this
Request Form is docketed within which I may withdraw, in writing, from the arbitration process. Once the request is withdrawn, I
cannot again file for fee arbitration. I understand that if the total fee charged is less than $3,000, a single attorney arbitrator may
hear the case; otherwise, three arbitrators would decide the case, unless I give my further written consent at the time of the hearing
to proceed with two arbitrators, in accord with the procedures set by Court Rule. I agree that the determination of a Fee
Committee is final and legally binding upon both the attorney and myself, and that the determination is subject to appeal only in
very limited instances of actual fraud, substantial procedural irregularities, failure of an arbitrator to properly be disqualified, or
where the arbitrators make an obvious mistake of law. I am further aware that if the attorney has sued me but I have filed a timely
Request Form, the Court Rules provide that the lawsuit will be stayed, and “the amount of the fee or refund as so determined [by
the Fee Committee] may be entered as a judgment in the action unless the full balance due is paid within 30 days of receipt of the
arbitration determination.” R. 1:20A-3(e). I also understand that, if no suit is pending, the determination of the Fee Committee
may, by summary action, be docketed as a judgment against me, under the same Court Rule. I also understand that fee
proceedings are confidential, and I agree to maintain the confidentiality required by R. 1:20A-5.
Client Certification
I hereby certify that all of the foregoing statements made by me are true, and that all documents attached are true copies of the
originals. I am aware that if any part of this Request Form is willfully false, I am subject to punishment.
Printed Name:
Please review the pamphlet “Information About New Jersey Attorney Fee Arbitration System” provided by the Fee Secretary.
Please Notify District Secretary of Disability Accommodation Needs, or If You Will Need the Services of an Interpreter.