Form Uc-25 - Notification Of Changes - 2016
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1STATE OF HAWAII
DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
UNEMPLOYMENT INSURANCE DIVISION
830 Punchbowl Street, Rm 437, Honolulu, Hawaii 96813
FORM UC-25, NOTIFICATION OF CHANGES
Name of Employer
UI Account Number
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. The 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. The employer is required to notify the Unemployment Insurance Division if employment
in Hawaii is resumed.
1.
Effective Date of Termination: (Month/Day/Year)
2.
Reason for discontinuation of employment:
Business in Hawaii suspended or discontinued entirely without a successor
Business in Hawaii acquired by a successor
Form of Organization changed to ________________________________ (corporation, individual, LLC, partnership, 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 the 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)
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 (Attach Documentation of Name Change)
2.
Trade Name (Attach Documentation of Name Change)
3.
Business Address
4. Business Telephone No.
(
)
5.
6. Business Fax No.
Mailing Address
(
)
7.
Type of Business
8. Federal I.D. No.
9.
Change in Ownership (Officers, Partners, Stockholders, etc)
Signed by
I certify that the information on this report is true and correct.
Title
Print Name
Phone Number
Date
(
)
Remarks
FOR OFFICIAL USE ONLY
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Rev. 08/16
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