REPLACE A LOST SOCIAL SECURITY CARD

Applicant's General Information

Gender*

Male

Female

First Name *

Middle Name (optional)

Last Name *

Did you have a different name at birth?

Yes

Birth First Name *

Birth Middle Name *

Birth Last Name *

Are you using other names?

Yes

Other First Name *

Other Middle Name*

Other Last Name *

Does the name on your most recent Social Security Card match your name above? *

Yes

First Name on most recent Social Security Card *

Middle Name on most recent Social Security Card

Last Name on most recent Social Security Card *

Social Security Number you had on the lost card *

Applicant's Birth Information

Country*

State *

City *

Date of Birth *

Applicant's parents information

Mother's first name *

Mother's middle name

Mother's last name (At Her Birth) *

Does your mother have a Social Security Number?

Yes

(If Deceased answer No)

Mother's Social Security Number *

SSN Unknown

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Father's first name *

Father's middle name

Father' last name *

Does your Father have a Social Security Card? *

Yes

(If Deceased answer No)

Father's Social Security Number *

SSN Unknown

Applicant's Mailing Address

Address *

Zip Code *

City *

State *

Agreement and Communication

By checking this box, I agree to submit the information provided to this website for the use of generating my SS-5 prefilled application. I agree that all information provided is truthful and accurate. I agree in full to the Terms of Service, Privacy Policy and Refund Policy provided on this website. I understand that the SSA provides forms and instructions for filings related to new, replacement, and updated cards at no charge. However, I request to use the SafeFiling customized filing instructions to prepare my application based on the information I have provided.

Daytime phone number *

Email Address *

Re-enter Email Address *