Trust & Non-Natural Owner Form (MYGA)

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This is the 72(u) Tax Deferred Treatment Certification Form.

Trust & Non-Natural Owner Form

Please complete and submit this form if you intend to designate a non-natural entity as the owner of your Pacific Guardian Life Insurance Company Annuity Contract. ALL SECTIONS MUST BE COMPLETED BY TRUSTEE(S) OR CORPORATE OFFICER OF OWNER


Using a blue or black ink pen

Submit in 1 of 3 Ways

Email: [email protected]

Fax: 1 (808) 942-1235

or Mail:
Pacific Guardian Life
1440 Kapiolani Blvd.,
Suite 1700
Honolulu, HI 96814