This form is a Renunciation and Disclaimer of an Individual Retirement Account (IRA), an Annuity, or Bond. The beneficiary has gained an interest in the proceeds of the account(s) due to the death of the decedent. However, the beneficiary has chosen to disclaim his/her rights to the proceeds pursuant to the Hawaii Revised Statutes, Chap. 526. The disclaimer will relate back to the death of the decedent and it will serve as an irrevocable refusal of the property. The form also contains a state specific acknowledgment and a certificate to verify delivery.