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Individuals & Families Resources

Individuals & Families

Annuity Systematic Withdrawal Form

This is the Annuity Systematic Withdrawal Form. If needed, please complete and submit the form.
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Authorization of Release of Health Related Information to PGL

This is the Authorization of Release of Health Related Information to PGL. If needed, please complete and submit the form.
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Authorized Representative Form

Use this form to authorize a third-person to receive information about your policy(ies).
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Bank Authorization (BA) Form

This is our Bank Authorization (BA) Form. This form is used to establish or change a bank account to make and/or receive payment for policies and contracts.
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Beneficiary Change Request Form

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

The Certificate of Trust Form is needed to establish the initial trust insurance and annuity policy/contract ownership with Pacific Guardian Life.
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Change of Ownership Form

This form is for a Change of Ownership for your policy or annuity.
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Check Delivery Authorization Form

If you would like to have your check delivered to someone other than yourself, please complete this form in its entirety.
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Contingent Owner Designation Form

This is the Contingent Owner Designation Form. Please complete the form and submit.
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Contract Information Update Form

Use this form to update/correct your contact information: name, mailing and email addresses, and phone number.
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Durable Power of Attorney Form for PGL Insurance and Annuity Accounts

This durable power of attorney form is used for your PGL insurance and annuity products. Throughout this form and the attached agreements the term “Account(s)” refers to your designated life insurance and annuity contracts with Pacific Guardian Life Insurance Co. Ltd.
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Establishing a New Attorney-In-Fact

This form serves as an agreement between Pacific Guardian Life Insurance Co. Ltd. (PGL) and the Attorney in Fact (AIF).
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Full or Partial Surrender Request Form

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

This is the Loan Request Form. If needed, please complete and submit the form.
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Non-Forfeiture Option Election Form

Non-Forfeiture Options are only available for specific life insurance plans.
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Policy Reissue & Reinstatement Application

This is the Policy Reissue and Reinstatement Application. If needed, please complete and submit the form.
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Premium Deposit Fund (PDF) Account Closing/Withdrawal Form

Use this form to close an existing PDF account attached to a policy.
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Premium Deposit Fund (PDF) Account Opening Form

Use this form to open a PDF account for a specific policy.
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MYGA

Annuitant/Ownership Service Form (MYGA)

If needed, please fill out the form and submit.
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Bank Authorization Form (MYGA)

This is our MYGA Bank Authorization Form. This form is used to establish or change a bank account to make and/or receive payment for policies and contracts.
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Request to Change Beneficiary Form (MYGA)

Allocations need not be equal. Allocations for primary beneficiaries must equal 100%. Allocations for contingent beneficiaries must equal 100%. If additional space is needed, please attach Supplemental Beneficiary form.
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Supplemental Beneficiary Form (MYGA)

BENEFICIARY DESIGNATION. Percentages from Supplemental Beneficiary page, and either the application or request to change in beneficiary form, must equal 100%.
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Systematic Withdrawal Request Form (MYGA)

If needed, fill out this form and submit.
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Trust & Non-Natural Owner Form (MYGA)

This is the 72(u) Tax Deferred Treatment Certification Form.
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Withdrawal/Surrender Request Form (MYGA)

This is a Withdrawal/Surrender Request Form that requires all information to be completed by the policy holder and for the completed form to be mailed, emailed, or faxed to Pacific Guardian Life.
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