Form SS-5, Application for a Social Security Card Completed Form Examples and Samples
Explore our example of a completed Form SS-5 for a U.S. citizen applying for a new Social Security card. This detailed illustration provides guidance for filling out the application, highlighting key sections such as personal information, citizenship, and mailing address. Ideal for anyone seeking a seamless application process.
Form SS-5 Example – New Social Security Card for U.S. Citizen
How this form was filled:
This example demonstrates how to fill out Form SS-5 for a U.S. citizen applying for a new Social Security card. The form includes detailed information such as full name, date of birth, and citizenship status.
Information used to fill out the document:
- Full Name: John Michael Smith
- Date of Birth: 1985-06-15
- Place of Birth: Los Angeles, California, USA
- Citizenship: U.S. Citizen
- Yes Veteran: No
- Mother's Maiden Name: Jane Doe
- Father's Name: Michael Smith
- Mailing Address: 456 Elm Street, Los Angeles, CA 90001
- Daytime Phone Number: (123) 456-7890
- Signature: John M. Smith
- Date: 2025-03-10
What this filled form sample shows:
- Correctly entered full name and date of birth
- Accurate designation of U.S. citizenship
- Properly formatted mailing address
- Appropriate signature and date
Form specifications and details:
| Use Case: | Obtaining a new Social Security card as a U.S. citizen |
| Form Purpose: | Application for a Social Security Card |
| Year: | 2025 |
