Form N-426 Request for Certification of Military or Naval Service

OMB No. 1615-0053 ; Expires 02/28/2013

Form N-426, Request for
Certification of Military or Naval Service

Department of Homeland Security
U.S. Citizenship and Immigration Services

Persons who are serving or have served under specified conditions in the Armed Forces of the United States 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.
Certification of the service member's military service listed on this form is required. Submit this form with Form N-400, Application for
Naturalization. For further assistance, contact the Military Help Line, 1-877-CIS-4MIL (1-877-247-4645) or visit www.uscis.gov/
military.
Alien Registration Number

For USCIS Use Only
Date Returned:
To:
Initials:
Comments:

Date of Request

Military Service Number

A
Name Used During Military Service (Last, First, Middle)

U.S. Social Security Number

Date of Birth

Place of Birth (Country and City)

Present Address:
Phone Number(s):

E-Mail Address(es):

Military Service
List all periods of service. (attach an additional sheet(s) if you need to provide more information.)
TO BE COMPLETED BY
CERTIFYING OFFICIAL

TO BE COMPLETED BY
APPLICANT OR CERTIFYING OFFICIAL
Branch of Service

Date Service Began

Date Service Ended

Type of Service (includes all active, reserve,
and National Guard Service)
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*

Applicant served honorably or
is currently serving honorably?
Yes

No (give details in Remarks)

Yes

No (give details in Remarks)

Yes

No (give details in Remarks)

*Selected Reserve of the Ready Reserve members: (1) participate in at least 48 scheduled drills or training periods during each year and serve on active duty for
training at least 14 days each year; or (2) participate in training at encampments, maneuvers, outdoor target practice, or other exercises at least 15 days each year.
(10 U.S.C. 10143)

Where did the applicant enlist (Country, State, and City where the applicant entered service)?
Has the applicant reenlisted?

Yes

Where did the applicant reenlist?

No

Signature of Applicant

Separation Information
Is the applicant separated?

Yes

No

If separated, select discharge type:

Honorable

Other (give details in Remarks section)

Was the applicant discharged on account of alienage?

Yes

No (if "Yes," give details in Remarks section)

Remarks
Use for continuation of any of the above items. You should also list in the space below any derogatory information in your records relating to the service
member's character, loyalty to the United States, disciplinary actions, convictions, or other matters concerning his or her fitness for citizenship. (Use a blank sheet
if more space is needed.)

Certification
TO BE COMPLETED BY CERTIFYING OFFICIAL
I am authorized to certify that the information given here concerning the service of the person named on this form is correct according to the records of the
Official Signature
Name of Department
[SEAL, if available]
(No State-issued notary
Public seals accepted.)

Name and Title
Date _______________, ______________

Phone Number and E-Mail Address
Form N-426 (02/09/12) Y