Va Form 26-1880 - Request For A Certificate Of Eligibility - 2008
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1OMB Control No. 2900-0086
Respondent Burden: 15 minutes
Department of Veterans Affairs
Eligibility Center
TO
P.O. Box 20729
REQUEST FOR A CERTIFICATE OF
Winston-Salem, NC 27120
ELIGIBILITY
NOTE: Please read information on reverse before completing this form. If additional space is required, attach a separate sheet.
1. FIRST-MIDDLE-LAST NAME OF VETERAN
2. DATE OF BIRTH
3. VETERAN'S DAYTIME TELEPHONE NO.
4A. ADDRESS OF VETERAN
(No., street or rural route, city or P.O., State
(Complete ONLY if the Certificate is to be
5. MAIL CERTIFICATE OF ELIGIBILITY TO:
and ZIP Code)
mailed to an address different from the one listed in Item 4A)
(If applicable)
4B. E-MAIL ADDRESS OF VETERAN
(ATTACH PROOF OF SERVICE - SEE PARAGRAPH "D" ON REVERSE)
6. MILITARY SERVICE DATA
E. SERVICE
B. PERIODS OF ACTIVE SERVICE
(Show your name exactly as it appears
C. NAME
D. SOCIAL SECURITY
F. BRANCH OF
A. ITEM
NUMBER
(If different from
on your separation papers or Statement of Service)
NUMBER
SERVICE
DATE FROM
DATE TO
Social Security No.)
1.
2.
3.
4.
7A. WERE YOU DISCHARGED, RETIRED OR SEPARATED FROM SERVICE BECAUSE OF DISABILITY
7B. VA CLAIM FILE NUMBER
OR DO YOU NOW HAVE ANY SERVICE-CONNECTED DISABILITIES?
C-
YES
NO
(If "Yes," complete Item 7B)
8. PREVIOUS VA LOANS
(Must answer N/A if no previous VA home loan. DO NOT LEAVE BLANK)
B. TYPE
F. DATE PROPERTY WAS
E. DO YOU
D. DATE
G. VA LOAN NUMBER
(Home, Refinance,
(Submit a copy of
STILL OWN
SOLD
A. ITEM
C. ADDRESS OF PROPERTY
OF LOAN
Manufactured Home,
(If known)
HUD-1, Settlement
THE PROPERTY?
or Direct)
Statement, if available)
(YES/NO)
1.
2.
3.
4.
5.
6.
I CERTIFY THAT the statements herein are true to the best of my knowledge and belief.
9. SIGNATURE OF VETERAN (Do NOT print)
10. 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 AFFAIRS.
FOR VA USE ONLY
11A. DATE CERTIFICATE ISSUED
11B. SIGNATURE OF VA AGENT
VA FORM
EXISTING STOCKS OF VA FORM 26-1880, JAN 2006,
26-1880
APR 2008
WILL BE USED.
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