Form Fc-4 - Application For Withdrawal, Foreign Corporation Page 3
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1
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3FORM FC-4
7/2011
Instructions: Application must be typewritten or printed in black ink, and must be legible. A
pplication must be signed by at least one
All signatures must be in black ink. Submit original application
officer of the corporation or by the chairperson of the board of directors.
together with the appropriate fee(s).
Line 1. Check whether the corporation is a profit or a nonprofit corporation.
Line 2. State the full name of the corporation.
Line 3. Give the name of the state or country where it was incorporated.
Line 6. Give the complete mailing address (including city, state and zip code) where any process may be mailed to the corporation by
the Director of Commerce and Consumer Affairs.
Filing Fees: Filing fees are not refundable. No personal or business checks accepted. Payment of the filing fee should be ONLY
in the form of CASH, CERTIFIED/CASHIER'S CHECK, BANK/POSTAL MONEY ORDER OR CREDIT CARD (Visa or MasterCard).
Make check or money order payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS.
Foreign Profit ($25)
Foreign Nonprofit ($10)
Dishonored Check Fee ($25)
For any questions call (808)586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign: Kauai
274-3141; Maui 984-2400; Hawaii 974-4000, Lanai and Molokai 1-800-468-4644 (toll free).
Fax (808)586-2733
Email Address:
breg@dcca.hawaii.gov
ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)
NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE
DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.
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