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Fillable Printable Form N-426

Fillable Printable Form N-426

Form N-426

Form N-426

Form N-426 07/25/17 N
Request for Certification
of Military or Naval Service
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form N-426
OMB No. 1615-0053
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
Family Name (Last Name)Given Name (First Name)Middle Name
1.Alien Registration Number (A-Number) (if any)
Names Used During Military Service
A-
Military Service Number2.
3.
U.S. Social Security Number (if any)4.
5.USCIS ELIS Account Number (if any)
Date of Birth (mm/dd/yyyy)6.
Place of Birth (city and country)7.
Physical Address8.
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.
Province or Region (foreign address only)
City or Town
Street Number and Name
ZIP Code + 4StateCounty
NumberFlr.Ste.Apt.
Postal Code (foreign address only)
Country (foreign address only)
-
Country
StateCity
Part 2. Enlistment Information
1.Where did you enlist?
Have you reenlisted?2.
YesNo
Where did you reenlist?3.
Country
StateCity
Page 1 of 4
Form N-426 07/25/17 N
Part 3. Periods of Military Service (To be completed by requestor)
Provide all periods of service. If you need extra space to complete this section, use the space provided in Part 9. Additional
Information.
Type of Service (include all active, reserve,
and National Guard Service)
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
Selected Reserve of the Ready Reserve*
Active Duty
* 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 a 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)
Part 4. Requestor's Contact Information, Certification, and Signature
Requestor's Contact Information
1.2.
3.Requestor's Email Address (if any)
Requestor's Daytime Telephone NumberRequestor's Mobile Telephone Number (if any)
Military Service
Military Service 1
Military Service 2
Military Service 3
Branch of Service
Date Service
Began
(mm/dd/yyyy)
Date Service
Ended
(mm/dd/yyyy)
Requestor's Certification
I authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities and
persons where necessary for the administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that all of the information in my request and any document submitted with it were provided by me
and are complete, true, and correct.
Requestor's Signature
Requestor's SignatureDate of Signature (mm/dd/yyyy) 4.
NOTE TO ALL REQUESTORS: USCIS may deny your request if you do not completely fill out this request or fail to submit
required documents listed in the Instructions.
Part 5. Character of Service (To be completed by Certifying Official)
State whether the requestor served honorably or is currently serving honorably for each period of military service the requestor served
(refer to Part 3. Periods of Military Service). If you answer “No,” provide details in Part 7. Remarks.
Honorable Period of Military Service 11.
YesNo
Honorable Period of Military Service 22.YesNo
Honorable Period of Military Service 33.YesNo
Page 2 of 4
Form N-426 07/25/17 N
Part 6. Separation Information
Is the requestor separated?1.
Yes
No
If separated, select discharge type: 2.
Other (provide details in Part 7. Remarks)Honorable
Was the requestor discharged on account of alienage? 3.
YesNo
If you answer “Yes,” provide details in Part 7. Remarks.
Part 7. Remarks
Provide any derogatory information in your records relating to the service member's character, loyalty to the United States,
disciplinary action, convictions, other than honorable discharges, or other matters concerning his or her fitness for citizenship. If you
need extra space to complete this section, use the space provided in Part 9. Additional Information.
Part 8. 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 request is correct
according to the records of the
Name of Department
Email Address (if any)
Daytime Telephone Number
Official SignatureName and Title
Date (mm/dd/yyyy)
Seal, if available (No state-issued
notary public seals accepted.)
Page 3 of 4
Form N-426 07/25/17 N
Part 9. Additional Information
If you need extra space to provide any additional information within this request, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this request or attach a separate sheet of paper. Include
your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which
your answer refers; and sign and date each sheet.
A-Number (if any)
3.
2.
Page Number
B.Part NumberC.Item Number
D.
A.
A.
A.
A.
Page Number
5.
Page Number
Part NumberItem NumberC.B.
D.
6.
D.
B.C.
Item NumberPart Number
Page Number
Part NumberItem Number
1.Family Name (Last Name) Given Name (First Name) Middle Name
C.B.
D.
4.
A-
Page 4 of 4
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