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Full or Partial Surrender Request Form

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This form is for a Full or Partial Surrender Request. Please complete the form and submit.

Full or Partial Surrender Request Form

Before completing this form, please know:

  • A full surrender is irreversible and your policy will not be eligible for reinstatement.
  • A partial surrender will affect the cash value and affect the health of your policy.
  • If your cash value is depleted, your policy will terminate.
  • Cash surrender distributions $2,500 and greater will require a notarized signature if not submitted to and signed by your servicing agent. Submissions directly made to a PGL office in person with proof of identification will not require notary.

Download & Print

Full or Partial Surrender 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