Form N-426 - Request For Certification Of Military Or Naval Service
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1
2
3
4Request for Certification
of Military or Naval Service
USCIS
Form N-426
Department of Homeland Security
OMB No. 1615-0053
U.S. Citizenship and Immigration Services
Expires 07/31/2019
Persons who are serving or have served under specified conditions in the U.S. Armed Forces are granted certain exemptions from the
general requirements for naturalization. To establish eligibility, the law requires the department with custody of the service record to
certify whether the service member served honorably, and whether each separation from the service was under honorable conditions.
USCIS requests certification of the service member's military service. Recruiters are not authorized to certify this request. Submit
this request with Form N-400, Application for Naturalization.
Instructions: Requestors must complete Parts 1. - 4. Certifying officials must complete Parts 5. - 8.
Part 1. Information About You
1.
Alien Registration Number (A-Number) (if any)
2.
Military Service Number
►
A-
3.
Names Used During Military Service
List all names you have used, including your maiden name (if any). If you need extra space to complete this section, use the
space provided in Part 9. Additional Information.
Family Name (Last Name)
Given Name (First Name)
Middle Name
4.
U.S. Social Security Number (if any)
5.
USCIS ELIS Account Number (if any)
6.
Date of Birth (mm/dd/yyyy)
►
►
7.
Place of Birth (city and country)
8.
Physical Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
County
State
ZIP Code + 4
-
Province or Region (foreign address only)
Country (foreign address only)
Postal Code (foreign address only)
Part 2. Enlistment Information
1.
Where did you enlist?
City
State
Country
2.
Have you reenlisted?
Yes
No
3.
Where did you reenlist?
City
State
Country
Page 1 of 4
Form N-426 07/25/17 N
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