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 03/31/2023

► START HERE - Type or print in black ink.

Part 1. Information About Service Member
1.

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

3.

Full Legal Name

2.

Family Name (Last Name)

4.

DOD ID Number

Given Name (First Name)

Middle Name (if applicable)

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NOT FOR
PRODUCTION
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5.

USCIS Online Account Number (if any)
►

Date of Birth (mm/dd/yyyy)

Part 2. Service Member's Certification and Signature
Service Members's Certification

I authorize release of information contained in this request, supporting documents, and from any of my records that USCIS may need
to determine my eligibility for the immigration benefit that I seek, and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that I provided or authorized all of the information in my request. I understand all of the
information contained in, and submitted with, my request, and I certify, under penalty of perjury, that all of this information is
complete, true, and correct.

Service Member's Signature
1.

Service Member's Signature

Date of Signature (mm/dd/yyyy)

Part 3. Certifying Official Attestation
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 service member's
honorable service. I have personally reviewed the service member'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 of the service member's current branch of service.
I further certify that

:
service member's name

1.

is currently serving in

since
branch of service

date service started (mm/dd/yyyy)

2.

is currently serving:

honorably

not honorably

3.

the type of service is:

Active Duty

Selected Reserve of the Ready Reserve or

Form N-426 Edition 03/01/21

Other

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Part 3. Certifying Official Attestation (continued)
Information About the Certifying Official
Branch of Service

Unit (such as Military Base, Vessel, Battalion, Brigade)

Work Telephone Number

Military Email Address

Certifying Official's Signature

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NOT FOR
PRODUCTION
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Official Signature

Date of Signature (mm/dd/yyyy)

Part 4. Remarks

Provide any derogatory information in your records relating to the service member's character, loyalty to the United States, criminal or
unlawful conduct investigations, pending court martials, convictions, discharges characterized as other than honorable, bad conduct, or
dishonorable, or other matters concerning his or her fitness for citizenship. If you need extra space to complete this section, please
provide a signed written statement.

Form N-426 Edition 03/01/21

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