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Form Uc-347 - Notification Of Acquisitions Or Transfers - State Of Hawaii Department Of Labor And Industrial Relations Page 2

STATE OF HAWAII

DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS

UNEMPLOYMENT INSURANCE DIVISION

Princess Keelikolani Building, 830 Punchbowl Street, Rm 437, Honolulu, Hawaii 96813

Form UC-347, Notification of Acquisitions or Transfers

In accordance with Section 383-66(b), Hawaii Revised Statutes, the Department of Labor and Industrial Relations is

hereby notified of an acquisition or a transfer of an organization, trade or business. (See instructions – “Who Must File The

Notification?”)

1. Transferring Employer’s Name

DOL Account No.

2. Acquiring Employer’s Name (If you are not an employer, skip and

DOL Account No.

proceed to item no. 3)

3. Acquiring Individual’s Name

Social Security No.

Provide date of the acquisition or transfer.

5. Was the acquisition or transfer total or partial?

6. If the acquisition or transfer included part of the workforce, provide percentage

__________%

7. Will the activity of the acquired organization, trade or business be continued?…………………………………………...

Yes

If No, what will the new activity be?

8. Will new employees be hired to perform duties unrelated to the business acquisition or transfer?………

Yes

Phone No.

9. Name of person to contact for additional information.

10. Form completed by: check one

Transferring employer

Acquiring employer or individual

CERTIFICATION: I certify that the information provided is correct to the best my knowledge and belief. I am the

employer or individual named above or I am authorized to act on the behalf of the employer or individual name above.

Signature__________________________________________________________________ Date_________________

Print Name and Title _____________________________________________________ Phone No.________________

For Unemployment Insurance Division Use Only

Mandatory

Prohibited

No Action Taken

Reviewed by __________________________________________ Date_________________

Signature

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Rev. 08/16

Form Uc-347 - Notification Of Acquisitions Or Transfers - State Of Hawaii Department Of Labor And Industrial Relations Page 2