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All Forms
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| Category | Form Number | Title | Description |
|---|---|---|---|
| Annuity Distribution | 10438 (PDF, 465K) | Annuity / Settlement Option Withdrawal Service Request | Used for partial withdrawals and full surrender of Annuities or Settlement Options Instruction Sheet(s): 10438INS (PDF, 85K) |
| Annuity Distribution | 14642 (PDF, 359K) | Automatic Payout Option | Used to establish an Automatic Payout Option or to make changes on an existing automatic payout option. Instruction Sheet(s): 14642INS (PDF, 84K) |
| Annuity Distribution | 14643 (PDF, 374K) | Required Minimum Distribution Request for Ongoing Scheduled Payments | Used to establish the Required Minimum Distribution payout or to make changes on an existing required minimum distribution payout. Instruction Sheet(s): 14643INS (PDF, 80K) |
| Annuity Distribution | 14804 (PDF, 54K) | Request for Waiver of Surrender Charges for Health Care Facilities Confinement | Used to request a waiver of surrender charges due to health care facilities confinement. This must be submitted with the Required Minimum Distribution Request form (14643). |
| Annuity Distribution | 24143 (PDF, 166K) | Certification of Trust | This form is only needed when a contract is owned by a trust. This must be submitted with the Required Minimum Distribution Request form (14643). |
| Annuity Distribution | NC-4P (PDF, 37K) | Withholding Certificate for Pension or Annuity Payments - NC Department of Revenue | Required for North Carolina residents if they are electing not to have withholding on their distribution. This must be submitted with the distribution request form. |
| Life Insurance Distribution | 11090 (PDF, 139K) | Life Values Distribution | Used for distribution requests from Life Insurance Contracts. Choose the instruction sheet that corresponds to your requested distribution type. Instruction Sheet(s): 11090C (PDF, 83K) - Complete Surrender 11090P (PDF, 83K) - Partial Surrender (UL/VUL contracts only) 11090L (PDF, 83K) - Loans 11090DR (PDF, 82K) - Dividend Surrender (traditional life contracts only) 11090DC (PDF, 29K) - Dividend Option Change |
| Life Insurance Distribution | 24143 (PDF, 166K) | Certification of Trust | This form is only needed when a contract is owned by a trust. This must be submitted with the Required Minimum Distribution Request form (14643). |
| Billing and Payments | 1698-5 (PDF, 69K) | 403(b) Calculation Worksheet | 403(b) Calculation Worksheet |
| Billing and Payments | 23045A (PDF, 668K) | Payment Services Request - Direct Payment | Payment Services Request - Direct Payment |
| Billing and Payments | 23045B (PDF, 670K) | Payment Services Request - Direct Bill | Authorize Thrivent Financial for Lutherans to send your bill to the named person or entity |
| Billing and Payments | 23045C (PDF, 668K) | Payment Services Request - Group Bill | Authorize Thrivent Financial for Lutherans to send your bill to the named person or entity |
| Billing and Payments | 24815A (PDF, 15K) | Death Benefit Guarantee Waiver - UL | Request that Thrivent Financial for Lutherans stop mailing notices regarding termination and/or reinstatement of the Extended Death Benefit Guarantee |
| Billing and Payments | 24815B (PDF, 15K) | Death Benefit Guarantee Waiver - VUL | Request that Thrivent Financial for Lutherans stop mailing notices regarding termination and/or reinstatement of the Enhanced Death Benefit Guarantee |
| Billing and Payments | 5245 (PDF, 123K) | 403(b) Contribution Agreement | Request to remit 403(b) contributions for purchase of an annuity contract or mutual fund shares |
| Billing and Payments | 6568 (PDF, 145K) | Direct Payment Authorization |
Withdrawals are prepared each month on the withdrawal date you select (1-28) and are routed through the Federal Reserve System to the account owner’s financial institution. One withdrawal is produced for each Thrivent Direct Payment account, and for each withdrawal date selected. Withdrawals returned unhonored due to insufficient funds will automatically be presented a second time to the account owner’s financial institution for payment. Instruction Sheet(s): 6568INS (PDF, 113K) |
| Billing and Payments | V6406 (PDF, 110K) | Variable Products Allocation Change | Use this notice to make changes to your premium allocation and/or remit a payment on any of your Variable Products. |
| Death Claim Information | To request a claim form, contact 800-THRIVENT (800-847-4836). As always, your Thrivent Financial representative is also available to answer your questions. |
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| Disability Income Insurance | DI259 (PDF, 107K) | Disability Income Insurance claim form for all states except ME, NY, MA, NJ and NC | This form is used: • to file a claim under your disability income contract. Complete it immediately upon disability. • to claim benefits under both disability income and life contracts, it is not necessary to complete a separate form for each benefit. Do NOT use this form • if your only claim is for waiver on life contracts. Instead, complete the Life Premium Waiver/Disability Waiver Insurance Claim (LF259). Help |
| Disability Income Insurance | DI259A (PDF, 107K) | Disability Income Insurance claim form for ME, NY, MA, NJ and NC | This form is used: • to file a claim under your disability income contract. Complete it immediately upon disability. • to claim benefits under both disability income and life contracts, it is not necessary to complete a separate form for each benefit. Do NOT use this form • if your only claim is for waiver on life contracts. Instead, complete the Life Premium Waiver/Disability Waiver Insurance Claim (LF259A). Help |
| Hospital Confinement/Family Hospital | No claim forms are required. | Send a copy of your itemized hospital bill or the UB04. Include the diagnosis if not on the bill or UB04. |
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| Life Insurance Premium Waiver | 259A (PDF, 72K) | Life Premium Waiver/Disability Waiver claim form for Children in ME, NY, MA, NJ and NC | This form is used: |
| Life Insurance Premium Waiver | 259C (PDF, 72K) | Life Premium Waiver/Disability Waiver claim form for Children in all states except ME, NY, MA, NJ and NC | This form is used: • to file a child’s waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Total disability exists when a child is at least age five and, due to accidental bodily injury or disease, is unable to attend a regular school or a special education facility. Under some contracts the disability must begin after age five. Refer to the contract for specific requirements. Help |
| Life Insurance Premium Waiver | LF259 (PDF, 90K) | Life Premium Waiver/Disability Waiver claim form for Adults in all states except ME, NY, MA, NJ and NC | This form is used: • to file a waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Do not use this form if your only claim is for disability income or both life waiver and disability income. Instead, complete the Disability Income Insurance Claim (DI259). Help |
| Life Insurance Premium Waiver | LF259A (PDF, 90K) | Life Premium Waiver/Disability Waiver claim form for Adults in ME, NY, MA, NJ and NC | This form is used: • to file a waiver claim on a life contract. Complete it after four/six (per the contract) consecutive months of total disability. Do not use this form if your only claim is for disability income or both life waiver and disability income. Instead, complete the Disability Income Insurance Claim (DI259A). Help |
| Long Term Care Insurance | 23057 (Word, 293K) | Long Term Care Claim Packet for all states except ME, NY, MA, NJ and NC | This form is used to file a claim for Long Term Care benefits. Complete it once covered care begins. Help |
| Long Term Care Insurance | 23057A (Word, 309K) | Long Term Care Claim Packet for ME, NY, MA, NJ and NC | This form is used to file a claim for Long Term Care benefits. Complete it once covered care begins. Help |
| Medicare Supplement Insurance | No claim forms are required. | Most claims are filed electronically through the Medicare carrier. For claims not filed electronically, send the original Explanation of Medicare Benefits (EOMB) and the itemized bill. |
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| Variable Products | 15771 (PDF, 16K) | Telephone Transaction Authorization | Use this form to elect or revoke telephone transaction authorization on any of your variable products. Telephone transaction authorization authorizes Thrivent to accept and act upon telephone or electronic instructions for certain transactions. Be sure to fill out this form accurately and completely or your request for telephone transaction authorization may be delayed. |
| Variable Products | 15773 (PDF, 56K) | Subaccount Transfer Selection | Use this form for one-time, periodic transfer of funds between subaccounts on any of your variable products. Be sure to fill out this form accurately and completely or your request may be delayed. |
| Variable Products | V6406 (PDF, 109K) | Variable Products Allocation Change/Remittance Request | Use this form to make permanent changes to your premium allocation for future payments or make a one-time change with a payment on any of your variable products. Be sure to fill out this form accurately and completely or your request may be delayed. |
Disability Income Insurance
Frequently Asked Questions
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Disability Income Insurance Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Disability. As always, your Thrivent Financial representative is also available to answer your questions.
Frequently Asked Questions
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Disability Income Insurance Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Disability. As always, your Thrivent Financial representative is also available to answer your questions.
Long Term Care Insurance
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Long Term Care Insurance Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Long-term Care. As always, your Thrivent Financial representative is also available to answer your questions.
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Long Term Care Insurance Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Long-term Care. As always, your Thrivent Financial representative is also available to answer your questions.
Medicare Supplement Insurance
Frequently Asked Questions
No claim forms are required. If you have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Medicare Supplement Insurance, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Medicare Supplement Insurance. As always, your Thrivent Financial representative is also available to answer your questions.
Frequently Asked Questions
No claim forms are required. If you have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Medicare Supplement Insurance, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Medicare Supplement Insurance. As always, your Thrivent Financial representative is also available to answer your questions.
Life Insurance Premium Waiver Benefit
Frequently Asked Questions
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Life Insurance Premium Waiver Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Life Insurance Waiver Claims. As always, your Thrivent Financial representative is also available to answer your questions.
Frequently Asked Questions
If you are unable to print a form or have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Life Insurance Premium Waiver Claims, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Life Insurance Waiver Claims. As always, your Thrivent Financial representative is also available to answer your questions.
Hospital Confinement
No special forms or claim forms are required. If you have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Hospital Confinement, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Hospital Confinement. As always, your Thrivent Financial representative is also available to answer your questions.
No special forms or claim forms are required. If you have any questions, contact your Thrivent Financial claim representative at mail@thrivent.com, attention Hospital Confinement, or call 800-THRIVENT (800-847-4836), press 1 for the Customer Interaction Center, then press 3 for the Life and Health Center, then press 2 for Hospital Confinement. As always, your Thrivent Financial representative is also available to answer your questions.
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