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N-426 Form N-426 Form N-426 (Visa Pro)

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Form N-426 09/16/19
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 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.
Part 1. Information About You
Family Name (Last Name) Given Name (First Name) Middle Name
1. Alien Registration Number (A-Number) (if any)
Other Names Used
►
A-
Military Service Number2.
4.
►
U.S. Social Security Number (if any)5.
►
6. USCIS Online Account Number (if any)
Date of Birth (mm/dd/yyyy)7.
Country
Place of Birth
9. Country of Nationality10.Country of Citizenship
8.
Physical Address11.
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.
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)
-
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.
Family Name (Last Name) Given Name (First Name) Middle Name
Full Legal Name 3.
City
Page 1 of 5
(USPS ZIP Code Lookup)
Form N-426 09/16/19
Province (if applicable)
City
Province (if applicable)
Where did you reside when you reenlisted?5.
Country StateCity
StateCountry
4. Where did you reenlist?
Province (if applicable)
Province (if applicable)
Country StateCity
Part 2. Enlistment Information
1. Where did you enlist?
Have you reenlisted?3.
Yes No
Where did you reside when you enlisted?2.
Country StateCity
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.
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
Military Service
Military Service 1
Military Service 2
Military Service 3
Branch of Service
Service Start Date
(mm/dd/yyyy)
Service End Date
(mm/dd/yyyy)
Page 2 of 5
Form N-426 09/16/19
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 Number 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
Requestor's Signature Date of Signature (mm/dd/yyyy) 4.
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.
Honorable Period of Military Service 11. Yes No
Honorable Period of Military Service 22. Yes No N/A
Honorable Period of Military Service 33. Yes No N/A
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.
Yes No
If you answer “Yes,” provide details in Part 7. Remarks.
Page 3 of 5
Form N-426 09/16/19
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)
Military Email Address Work Telephone Number
Official Signature (NOTE: An original ink signature or a copy of an original ink signature is
acceptable. A digital signature is not acceptable.)
Date (mm/dd/yyyy)
I,
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
Full Name Rank Title
,
the records of the
.
Branch of Service
Component Rank
Full NameTitle
Page 4 of 5
Form N-426 09/16/19
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 Number C. Item Number
D.
A.
A.
A.
A.
Page Number
5.
Page Number
Part Number Item NumberC.B.
D.
6.
D.
B. C.
Item NumberPart Number
Page Number
Part Number Item Number
1. Family Name (Last Name) Given Name (First Name) Middle Name
C.B.
D.
4.
A-
Page 5 of 5
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N-426 Form N-426 Form N-426 (Visa Pro)

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Completed 18 July 2020

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