Va Form 26-1880 With Instructions - Request For Certificate Of Eligibility
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2OMB Control No. 2900-0086
Respondent Burden: 15 minutes
MAIL COMPLETED APPLICATION TO:
FOR VA USE ONLY
Department of Veterans Affairs
COE REF. NO.
Eligibility Center
P. O. Box 20729
REQUEST FOR CERTIFICATE OF ELIGIBILITY
Winston-Salem, NC 27120
NOTE: Please read information on reverse before completing this form. If additional space is required, attach a separate sheet.
1. NAME OF VETERAN (First, Middle, Last)
2. DATE OF BIRTH
3. SOCIAL SECURITY NUMBER
4A. DID YOU SERVE UNDER ANOTHER NAME?
4B. NAME(S) USED DURING MILITARY SERVICE (IF DIFFERENT FROM NAME IN ITEM 1)
YES
NO
(If "Yes," complete Item 4B)
5. DAYTIME TELEPHONE NUMBER
6. E-MAIL ADDRESS (If applicable)
(
)
7A. ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)
7B. MAIL CERTIFICATE OF ELIGIBILITY TO: (Complete ONLY if the Certificate is
to be mailed to an address different from the one listed in Item 7A)
8A. WERE YOU DISCHARGED, RETIRED, OR SEPARATED FROM SERVICE BECAUSE OF DISABILITY?
8B. VA CLAIM NUMBER (If known)
YES
NO
MILITARY SERVICE (SEE INSTRUCTIONS FOR PROOF OF SERVICE ON THE NEXT PAGE)
9A. ARE YOU CURRENTLY ON ACTIVE DUTY? (If you are currently serving on active duty, leave the "Date Separated" field blank)
YES
NO
IMPORTANT: Please provide your dates of service.
In many cases eligibility can be established based on
data in VA systems. However, it is recommended that
SERVICE NUMBER
BRANCH OF
DATE
OFFICER OR
proof of service be provided, if readily available. Proof
DATE ENTERED
(If different from
SERVICE
SEPARATED
ENLISTED
of service is required for persons who entered service
Social Security Number)
after September 7, 1980 and were discharged after
serving less than 2 years.
9B.
ACTIVE SERVICE - Do not include any periods
of Active Duty for Training or Active Guard Reserve
service. Do include any activation for duty under Title
10 U.S.C (e.g. Reserve or Guard unit mobilized)
9C.
RESERVE OR NATIONAL GUARD SERVICE
Include any periods of Active Duty for Training
(ADT) or Active Guard Reserve service. Do not
include any activation for duty under Title 10
U.S.C. (e.g. Reserve or Guard unit mobilized)
PREVIOUS VA LOANS (SEE INSTRUCTIONS ON THE NEXT PAGE - Attach a separate sheet if information for all homes will not fit in Item 10)
10A. DO YOU NOW OWN ANY HOMES(S) PURCHASED OR
10B. DATE OF LOAN
10C. STREET ADDRESS
10D. CITY AND STATE
REFINANCED WITH A VA-GUARANTEED LOAN?
(Month and Year)
YES
(If "Yes," complete Items 10B thru 10D)
NO
(If "No," skip to Item 14)
NOT APPLICABLE (NA) - I HAVE NEVER OBTAINED A
VA-GUARANTEED HOME LOAN (If "NA," skip to Item 14)
11A. ARE YOU APPLYING FOR THE ONE-TIME ONLY
11B. DATE OF LOAN
11C. STREET ADDRESS
11D. CITY AND STATE
RESTORATION OF ENTITLEMENT TO PURCHASE
(Month and Year)
ANOTHER HOME?
YES
NO
(If "Yes," complete Items 11B thru 11D)
12A. ARE YOU APPLYING FOR A RESTORATION OF
12B. DATE OF LOAN
12C. STREET ADDRESS
12D. CITY AND STATE
ENTITLEMENT TO OBTAIN A REGULAR (CASH-OUT)
(Month and Year)
REFINANCE ON YOUR CURRENT HOME?
YES
NO
(If "Yes," complete Items 12B thru 12D)
13A. ARE YOU REFINANCING AN EXISTING VA LOAN TO
13B. DATE OF LOAN
13C. STREET ADDRESS
13D. CITY AND STATE
OBTAIN A LOWER INTEREST RATE WITHOUT
(Month and Year)
RECEIVING ANY CASH PROCEEDS (IRRRL)?
YES
NO
(If "Yes," complete Items 13B thru 13D)
I CERTIFY THAT the statements in this document are true and complete to the best of my knowledge.
14A. SIGNATURE OF VETERAN (Do NOT print)
14B. DATE SIGNED
FEDERAL STATUTES PROVIDE SEVERE PENALTIES FOR FRAUD, INTENTIONAL MISREPRESENTATION, CRIMINAL CONNIVANCE OR
CONSPIRACY PURPOSED TO INFLUENCE THE ISSUANCE OF ANY GUARANTY OR INSURANCE BY THE SECRETARY OF VETERANS
DATE RETURNED
FOR VA USE ONLY (Please do not write below this line)
REASON(S) FOR RETURN
VA FORM
SUPERSEDES VA FORM 26-1880, APR 2008,
26-1880
MAR 2011
WHICH WILL NOT BE USED.
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