Hawaii Corporation Annual Report Form
If the above mailing address has changed, line out and print change to the right.
If address of principal office differs from the above mailing address, state the address of principal office. Include City, State, and Zip
1. AUTHORIZED SHARES TOTAL NUMBER OF SHARES ISSUED
CLASS NUMBER CLASS NUMBER
(To correct line out and print the correction to the right.)
(To correct, line out and print corrections below. If inactive during the period, state INACTIVE.)
2. NATURE OF BUSINESS:
3. The name of the registered agent and the registered agent’s street address of the place of business in Hawaii of the person to which
service of process and other notice and documents being served on or sent to the entity represented by it may be delivered to. (If any
change, line out and print change on the right. See reverse side for instructions.).
DIRECTOR CODE NAME IN FULL ADDRESS (INCLUDE CITY, STATE & ZIP CODE)
I certify under the penalties of Section 414-20, Hawaii Revised Statutes, that I have read the above, the information is true and
correct, and I am authorized to sign this report.
Signature of authorized officer, attorney-in-fact Print Name
for an officer, or receiver or trustee
(if the corporation is in the hands of a receiver or trustee)
File this Original
(SEE REVERSE SIDE FOR INSTRUCTIONS)
DOMESTIC PROFIT CORPORATION
FILING FEE: $ 15.00
STATE OF HAWAII
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
BUSINESS REGISTRATION DIVISION
335 Merchant Street
Mailing Address: Annual Filing, P.O. Box 40, Honolulu, HI. 96810
DOMESTIC PROFIT CORPORATION ANNUAL REPORT AS OF
CORPORATE NAME AND MAILING ADDRESS:
4. OFFICERS/DIRECTORS: List all officers and directors. (To correct, line out and print corrections to the right. See reverse for instructions.)INSTRUCTIONS
(If any questions, call: (808) 586-2727)
The annual report must be typewritten or printed in Black Ink, and must be legible. The report must be signed in black ink and
certified by an authorized corporate officer, attorney-in-fact for an officer, receiver, trustee or other court-appointed fiduciary.
The filing fee of $ 15.00 must be submitted with the report. Make check payable to the DEPARTMENT OF COMMERCE
AND CONSUMER AFFAIRS. Filing fee is not refundable. Your cancelled check is your receipt. There is a $ 25.00 charge
for all dishonored checks.
Failure to file an annual report for any year within the prescribed time will subject the corporation to a maximum penalty of
$100.00 for every thirty days the delinquency continues. The Director of Commerce and Consumer Affairs may administratively
dissolve the corporation for failure to file an annual report for a period of two years.
1. State the total number of authorized shares, itemized by class and series, if any, within each class, and the total number
of issued and outstanding shares, itemized by class and series, if any, within each class.
2. State a brief description of the nature of business. If inactive for the period, state INACTIVE. (Annual report must be filed for
the period, even though the corporation was inactive.)
3. State the name of the registered agent and the complete street address (including number, street, city, state, and zip code) in
Hawaii. The agent must be an individual resident of Hawaii, a domestic entity, or a foreign entity authorized to transact
business or conduct affairs in the State of Hawaii. A domestic corporation cannot be its own agent. (The Director of
Commerce and Consumer Affairs may administratively dissolve the corporation for failure to maintain a registered agent and
4. State the names and business addresses of all corporate officers and directors. (P=President; V=Vice-President;
S=Secretary; T=Treasurer; D=Director)
Due Date:Effective January 1, 2003, for a domestic or foreign corporation whose date of incorporation or registration in this
State falls between:
(1) January 1 and March 31, an annual report shall be filed on or before March 31 of each year and shall reflect the state of
the corporation’s affairs as of January 1 of the year when filed;
(2) April 1 and June 30, an annual report shall be filed on or before June 30 of each year and shall reflect the state of the
corporation’s affairs as of April 1 of the year when filed;
(3) July 1 and September 30, an annual report shall be filed on or before September 30 of each year and shall reflect the
state of the corporation’s affairs as of July 1 of the year when filed; and
(4) October 1 and December 31, an annual report shall be filed on or before December 31 of each year and shall reflect the
state of the corporation’s affairs as of October 1 of the year when filed.
New corporations: An annual report is not required to be filed in the year the corporation was incorporated.
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. All Business Registration filings are open to public inspection. (Section 92F-11, HRS)
Mail the completed report with fee to:
Annual filing – BREG
P.O. Box 40
Honolulu, HI 96810
DID YOU REMEMBER TO SIGN YOUR REPORT AND CHECK?
Renew online at ehawaii.gov/annuals