Hawaii Registration of Reciprocal Beneficiary Relationship
Official state formOther requestsFree downloadLast verified November 10, 2026
Notarized declaration by two adults who cannot legally marry each other to register a reciprocal beneficiary relationship under HRS chapter 572C. It is mailed to the RBR Office of the Hawaii Department of Health. Mail only.
Who can use this form
- Both parties must be at least 18 years old.
- Neither party may be married or in another reciprocal beneficiary relationship.
- The parties must be legally barred from marrying each other.
- Both parties sign before a notary.
What to send with it
- The form, signed by both parties and notarized.
- $8.00 money order or certified check payable to State Director of Finance (the office's page says cashier's check).
- One stamped, self-addressed, legal-size envelope.
- Two envelopes if the certificates go to different addresses.
Where to send it
- Mail to
- State Department of Health Office of Health Status Monitoring ATTN: RBR OFFICE PO Box 3378 Honolulu, HI 96801
- State fee
- $8.00. Extra copies of the certificate cost $8.00 each.
- Typical processing
- Not provided
- Form revision
- REV 2021 B
- Source
- Official government page