Form Uc-25 - Notification Of Changes

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Form UC-25
STATE OF HAWAII
(Rev. 5/97)
Department of Labor and Industrial Relations
Unemployment Insurance Division
NOTIFICATION OF CHANGES
_____________________________________________
___________________________________
Name of Employer
UI Account Number
INSTRUCTIONS: Please type or print. Complete Part I or Part II, whichever is applicable, and deliver to the Unemployment
Insurance Office where your account is maintained for correction and/or changes.
PART I. TERMINATION OF EMPLOYMENT/BUSINESS
NOTICE IS HEREBY GIVEN to the Hawaii Unemployment Insurance Division that the above named employer has suspended or
discontinued employment in Hawaii. Employer will not file a quarterly contribution report for periods after the termination date, until
such time in the future as the employer has one or more persons in employment under the Hawaii Employment Security Law.
Employer is required to notify the Unemployment Insurance Division if employment in Hawaii is resumed.
Month Day
Year
1. Effective Date of Termination:
______/______/______
2
Reason for discontinuation of employment:
_____
Business in Hawaii acquired by a successor
_____
Business in Hawaii suspended or discontinued entirely without a successor
_____
Form of Organization changed to __________________________________
(corporation, individual, etc.)
_____
Business in Hawaii continued in operation without employment after date in item 1.
3. Name and address of person who will be responsible for employer’s records hereafter:
4. Name and address of successor in business:
5. Was all or part of the business sold?
ALL _____ PART _____
(FOR INFORMATION ON TRANSFERS OF RATES AND RESERVES FROM A PREDECESSOR, CONTACT THE
UNEMPLOYMENT INSURANCE OFFICE)
PART II. CORRECTIONS AND CHANGES
NOTICE IS HEREBY GIVEN to the Hawaii Unemployment Insurance Division of the following changes and/or corrections:
1. Name
2. Trade Name
3. Business Address
4. BusinessTelephone
5. Mailing Address
6. Business FAX
7. Type of Business
8. Federal I.D.No.
9. Change in Ownership (Officers, Partners, Stockholders, etc)
I certify that the information on this report is true and correct.
Signed by:
Title:
Print Name:
Phone Number:
Date:
If you need any assistance in completing this form or if you need further information, please contact the appropriate office listed below:
OAHU: Employer Services Section
HAWAII: Kaiko’o Mall, #122
MAUI: 54 S. High St, # 201
KAUAI: 3100 Kuhio Hwy, #C-12
P.O. Box 700
777 Kilauea Ave.
Wailuku, HI 96793-2198
Lihue, HI 96766-1153
Honolulu, HI 96809-0700
Hilo, HI 96720-4291
Telephone: 984-8410
Telephone: 274-3025
Telephone: 586-8913 or 586-8914
Telephone: 974-4086
FAX: (808) 984-8444
FAX: (808) 274-3028
FAX: (808) 586-8929
FAX: (808) 974-4085
FOR OFFICIAL USE ONLY:
Remarks:

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