"In that_____________________did, (at) (on board)_____________________, on or about _____________________19__, wrongfully and unlawfully (promise) (offer) (give) to _____________________(his/her commanding officer) (the claims officer of _____________________) (_____________________), (the sum of $_____________________) (_____________________, of a value of (about) $_____________________) (_____________________) with the intent to influence the (decision) (action) of the said_____________________with respect to] [(as compensation for) (in recognition of) services (rendered) (to be rendered) (rendered and to be rendered) by the said _____________________in relation to] an official matter in which the State of Hawaii was and is interested, to wit: (the granting of leave to_____________________) (the processing of a claim against the State of Hawaii in favor of_____________________) (_____________________)."
Haw. Code R. § 7-9-4