Notice Of Data Event

Establishing a New Attorney-In-Fact

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This form serves as an agreement between Pacific Guardian Life Insurance Co. Ltd. (PGL) and the Attorney in Fact (AIF).

If you are a now servicing AIF for a springing Power of Attorney or a successor AIF, you must also include a letter from a doctor or hospital administrator on their letterhead as proof of the principal’s incapacitation.

Before completing this form, please know that this form is not to be used:

  • By a trustee to appoint an agent or successor trustee
  • To name an AIF to act on behalf of a trust
  • To establish court appointed fiduciaries (e.g. estates, guardianships, conservators, etc)
  • To name a Trusted Contact Person


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