Certificate of Service – Hawaii

The Certificate of Service is a Labor and Industrial Relations Appeals Board (LIRAB) form, issued for the State of Hawai‘i, on which a party certifies that a copy of the document being filed was sent to the persons named, by the method of service and on the date noted.

The form has two parts. The first page holds the filer's contact information and role, the LIRAB caption, and the title of the document being served. The caption has lines for the AB No., the DCD No. and the accident date, and it names the Claimant, the Employer and the Insurance Carrier. The next page is the certificate itself, headed CERTIFICATE OF SERVICE, with the instruction to attach it as the last page of documents filed. It reads: "I hereby certify that a copy of the foregoing document was sent to the following by the method of service and on the date noted below." It then provides two recipient blocks, each with name, address, email address and method of service, and ends with the date, a signature line and the printed name.

The certificate is not a motion, notice or request of its own: it accompanies another document and records how that document was served. The Board's forms page describes the samples and forms it offers as suggested language that may be modified to suit individual needs, not as legal advice and not as a replacement for state law, administrative rules or Board decisions and orders.

The form is for a person filing a document in a matter before the Labor and Industrial Relations Appeals Board who must show that copies of the document were sent to the other persons involved. The caption names three kinds of participants: the Claimant, the Employer and the Insurance Carrier. The filer identifies his or her own role in the Identify your Role field and lists the contact details at the top of the form.

• The filer. Whoever submits the document completes the certificate, signs it and prints his or her name. The form shows one signature line and no separate block for a representative, so check the Board's rules if someone else will sign for you.
• The recipients. Each person who is sent a copy goes in a recipient block with name, address and email address. The form has room for two.

The form is attached to a document that is being filed; it is not filed alone. The Board's forms page says that its forms are for the convenience of parties and should not replace legal advice or independent review of the law.

Complete the Certificate of Service each time you file a document in your LIRAB matter: the form says to attach it as the last page of the documents filed. It records the date and the method by which a copy of the document was sent to each person listed, so it is prepared when the document is served. No separate due date is printed on it. Any deadline for the document you are filing comes from the Board, not from this certificate, so confirm it with LIRAB.

The Certificate of Service has no filing channel of its own: you attach it as the last page of the document you file, and the same document is sent to every person named in the recipient blocks.

• With the filed document. Place the completed certificate after the last page of the document, as the form instructs, and submit the whole package the way you submit that document to the Labor and Industrial Relations Appeals Board. The form prints no mailing address, portal or office hours.
• To each recipient. Send a copy of the foregoing document to each person listed, by the method you enter on the form (the Method of Service line shows Email), and enter the date in Dated.

Sign the form and print your name before sending. FillingPDF lets you fill out and download the PDF; submission follows the channels above.