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

Request for Certification
of Military or Naval Service

USCIS
Form N-426

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

OMB No. 1615-0053
Expires 09/30/2021

USCIS requests certification of the service member's military service. 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 executive department under which such person served to certify whether the service member served
honorably, and whether the service member's separation from the service was under honorable conditions pursuant to Department of
Defense (DoD) policy and guidelines. Recruiters are not authorized to certify this request.
NOTE: Requestors must complete Parts 1. - 4. Certifying officials must complete Parts 5. - 8. All applicants must submit a
completed Form N-426; however, only applicants currently serving are required to obtain certification of Form N-426. Submit this
request with Form N-400, Application for Naturalization. USCIS may reject your application if this request is not completely and
properly filled out.
NOTE: ONLY military personnel (serving in pay grade O-6 or above) and equivalent civilian personnel (GS-15 or above) with
proper authorization may certify this request.

Part 1. Information About You
1.

Alien Registration Number (A-Number) (if any)
► A-

3.

Full Legal Name
Family Name (Last Name)

4.

2.

Military Service Number

Given Name (First Name)

Middle Name

Other Names Used
List all other 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)

5.

U.S. Social Security Number (if any) 6.
►

8.

Place of Birth

9.

Given Name (First Name)

USCIS Online Account Number (if any)
►

Middle Name

7.

City

Country

Country of Citizenship

10. Country of Nationality

Date of Birth (mm/dd/yyyy)

11. Physical Address

(USPS ZIP Code Lookup)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

County

State

Province or Region (foreign address only)

Country (foreign address only)

Postal Code (foreign address only)

Form N-426 09/16/19

ZIP Code + 4
-

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Part 2. Enlistment Information
1.

Where did you enlist?
Country

City

State

City

State

City

State

City

State

Province (if applicable)

2.

Where did you reside when you enlisted?
Country

Province (if applicable)

3.

Have you reenlisted?

4.

Where did you reenlist?

Yes

No

Country

Province (if applicable)

5.

Where did you reside when you reenlisted?
Country

Province (if applicable)

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.
NOTE: If you have multiple periods of military service and are separated from service, you must provide your most current DD
Form 214 or NGB Form 22.
Military Service
Military Service 1
Military Service 2
Military Service 3

Form N-426 09/16/19

Branch of Service

Service Start Date
(mm/dd/yyyy)

Service End Date Type of Service (include all active, reserve,
(mm/dd/yyyy)
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

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Part 4. Requestor's Contact Information, Certification, and Signature
Requestor's Contact Information
1.

Requestor's Daytime Telephone Number

3.

Requestor's Email Address (if any)

2.

Requestor's Mobile Telephone Number (if any)

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
4.

Requestor's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL REQUESTORS: USCIS may reject or deny your Form N-400 if you do not complete this Form N-426, or if you
do not submit all required documents listed in the Instructions.

Part 5. Character of Service (To be completed by certifying official)
NOTE: For armed forces members currently serving, the certifying official MUST complete AND certify Form N-426 in Parts 5. - 8.
Veterans who are no longer serving may leave Parts 5. - 8. blank, but MUST provide copies of their DD Form 214 or NGB Form 22
that include the character of service upon separation from service for all periods of service.
For this character of service section, the certifying official must indicate 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). For any “No”
responses, provide details in Part 7. Remarks.
1.

Honorable Period of Military Service 1

Yes

No

2.

Honorable Period of Military Service 2

Yes

No

N/A

3.

Honorable Period of Military Service 3

Yes

No

N/A

Yes

No

Part 6. Separation Information
1.

Is the requestor separated?

2.

If separated, select discharge type:

3.

Was the requestor discharged on account of alienage?

Honorable

Other (provide details in Part 7. Remarks)
Yes

No

If you answer “Yes,” provide details in Part 7. Remarks.

Form N-426 09/16/19

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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,
Full Name
Rank
Title
certify that I am duly authorized under the laws, regulations and policies of the Department of Defense to certify the requestor's
honorable service. I have personally reviewed the requestor's service record. The information provided herein is a reflection of my
findings. I certify that the information given here concerning the service of the person named on this request is correct according to
the records of the

.

Branch of Service

Component

Title

Full Name

Work Telephone Number

Military Email Address

Official Signature (NOTE: An original ink signature or a copy of an original ink signature is
acceptable. A digital signature is not acceptable.)

Form N-426 09/16/19

Rank

Date (mm/dd/yyyy)

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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.
1.

Family Name (Last Name)

Given Name (First Name)

2.

A-Number (if any) ► A-

3.

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

Middle Name

D.

4.

A. Page Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

Form N-426 09/16/19

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