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Hawaii - For your protection Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment or both. BN-658-AWD-0212 EMPLOYER S REPORT OF CLAIM Name of Employer Mailing Address include street city state and zip code Social Security Number Phone No. E M P Address include street city state and zip code L O Y Date of Hire Fax No. Effective date of employee s c...

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