Notice Of Data Event

Authorized Representative Form

See all:

Employer Resources
Individuals & Families Resources


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

Authorized Representative Form


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