Notice Of Data Event

Change of Ownership Form

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This form is for a Change of Ownership for your policy or annuity.

Change of Ownership Form

Before completing this form, please know:

  • This form may not be used for Qualified Accounts.
  • Depending on your personal financial situation, a change of ownership of a life insurance or annuity contract may be a taxable event. It is highly recommended you consult with a tax and/or legal professional to consider potential tax and estate implications.
  • The new Owner will be listed as the Payor of the policy unless instructed otherwise.
  • For Annuity contracts: If the new owner is a revocable trust or an irrevocable grantor trust, the annuitant must be the grantor of the trust to assure compliance with Section 72(s) of the Internal Revenue Code. For joint grantor trusts, both grantors must be annuitants, unless only one grantor’s separate property is used to fund the annuity, in which case that grantor must be the annuitant. TDI.

Download & Print


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