Beneficiary Change Request Form

Request Information

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This form is used to establish and change the beneficiary designation of a life insurance policy or annuity contract.

Beneficiary Change Request Form

Before completing this form, please know:

By completing, signing, and submitting this form you are revoking and changing any and all previous beneficiary designations.
Insurance regulations require insurance companies to request supplemental beneficiary information. Please complete all information requested in Section 3 of this form.
The change requested will be effective from the signature date.

Download & Print

Beneficiary Change Request Form

Complete

Using a blue or black ink pen

Submit in 1 of 3 Ways

Email: [email protected]

Fax: 1 (800) 946-1295

or Mail:
Pacific Guardian Life
Attn: Client Relations Department
1440 Kapiolani Blvd.,
Suite 1700
Honolulu, HI 96814