Form Uc-86 - Waiver Of Employer'S Experience Record

Form UC-86

Rev 08/16

STATE OF HAWAII

DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS

Unemployment Insurance Division

830 Punchbowl Street, Room 437

Honolulu, Hawaii 96813

FAX(808)5868929

Phone (808) 586-8914

WAIVER OF EMPLOYER’S EXPERIENCE RECORD

The Department of Labor and Industrial Relations is hereby notified that the undersigned successor employing unit

succeeded to or acquired the organization, trade, or business, or substantially all the assets thereof, and continues to employ all

or nearly all the employees of the undersigned predecessor employing unit, an employer subject to the Hawaii Employment

Security Law, and the last day prior to acquisition by the successor employing unit is the

day of

, 20

In accordance with the provisions of Section 383-66(a)(5) of the Hawaii Revised Statutes, the predecessor employing

unit hereby relinquishes all rights to its prior experience record with respect to its separate account, contribution payment and

benefit chargeability experience, annual payrolls, and other data for the purpose of obtaining a reduced rate of contributions

and requests the Department of Labor and Industrial Relations to permit such experience record to inure to the benefit of said

successor employing unit. The successor employing unit hereby requests that such experience record inure to its benefit.

Executed this

day of

, 20

INSTRUCTIONS: This waiver must be signed by

(Firm or Trade Name of Predecessor)

Account Number

(1) the sole proprietor, (2) a duly authorized officer, if

employer is a corporation, (3) a duly authorized

By ________________________________________________

partner/member of a partnership or limited liability

company, or (4) a duly authorized person, if employer

___________________________________________________

is an unincorporated association. An agent may sign

(Title)

the waiver in the name of the employer if an acceptable

power of attorney is filed with the Unemployment

Insurance Division.

(Firm or Trade Name of Successor)

Account Number

By _________________________________________________

____________________________________________________

(Title)

In order to assume the lower rate of the predecessor employing unit immediately upon acquisition of the business, (1) the

employer newly subject to the law must file this form within sixty (60) days after the date of acquisition, and (2) the

predecessor must file all reports and remit all contributions (including penalty and interest) within sixty (60) days after the

transfer of the business. In some circumstances, the predecessor employing unit’s quarterly contribution report and remittance

must be submitted before the quarterly due date to satisfy the sixty (60) day deadline. WARNING: There are no provisions in

the Hawaii Employment Security Law and/or Administrative Rules to relax the sixty (60) day filing requirement.

Successor employers failing to file this form with the Division within sixty (60) days after the transfer of the business,

may file this form by March 1

of the following year at which time, if the predecessor employer has filed all reports and paid

all contributions due, the experience records of the predecessor and successor employers will be combined to determine the

rate for the successor employer for the new calendar year. This form shall be returned unprocessed if submitted on or after

December 31 of the calendar year following the calendar year in which the acquisition occurred. Similarly, there are no

provisions in the Hawaii Employment Security Law and/or Administrative Rules to relax these filing requirements.

New employing units succeeding two or more predecessor employers simultaneously are treated differently and the

Hawaii Employment Security Law should be referred to in these instances.

______________________________________________________________________________________________________

Unemployment Insurance Division Use Only

Approved by

Title

Date

Form Uc-86 - Waiver Of Employer'S Experience Record - 2016

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