"In that_____________________, being in the presence of (a) (an) [(general) (special; court-martial] [duly appointed board of officers] [officer taking a deposition] [_____________________of which_____________________was (military judge) (president), (_____________________), (and having been directed by the said_____________________to answer the following questions put to him/her as a witness, "_____________________" did, (at) (on board) on or about_____________________19__, wrongfully refuse (to qualify as a witness) (to answer said questions)."
Haw. Code R. § 7-9-24