Replace A Lost Card

Applicant's General Information

1.
2.i.
2.ii.
2.iii.
3.
3.i.
3.ii.
3.iii.
4.
4.i.
4.ii.
4.iii.
5.
5.i.
5.ii.
5.iii.
6.

Applicant's Birth Information

7.i.
7.ii.
7.iii.
8.

Applicant's Citizenship

9.
10.
11.
12.
13.

Applicant's Parents Information

14.i.
14.ii.
14.iii.
15.
(If Deceased answer No)
15.i.
16.i.
16.ii.
16.iii.
17.
(If Deceased answer No)
17.i.

Applicant's Mailing Address

18.i.
18.ii.
18.iii.
18.iv.

Relationship with Applicant

19.
19.i.

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 Safe-Apply customized filing instructions to prepare my application based on the information I have provided.

Safe-Apply.co is a document preparation and filing service company that is not affiliated nor endorsed by the Social Security Administration (SSA). A blank SS-5 form can be found for free by visiting the SSA website or your local office. We do not charge for the form, however, we charge for assisting you in completing the form. We do not review the information you submit on a legal or accounting stance, or any other professional standpoint.

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