Loan Request Form

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This is the Loan Request Form. If needed, please complete and submit the form.

Loan Request Form

Before completing this form, please know:

A loan will affect the cash value and charge an interest rate which may affect the health of your policy.
If your loan balance exceeds your policy cash values, your policy will terminate.
Loans $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

Loan 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