Notice Of Data Event

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


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