Forms

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800-847-4836

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Thrivent Financial member meeting with Financial Representative

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Phone 888-834-7428

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CloseReport the Death of a Loved One

Starts the claims process by reporting the loss of a loved one.

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CloseAddress Change

Call 800-847-4836 or select "Update Personal Information" after logging into MyThrivent.

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CloseDistribution – Annuity

Partial withdrawals can be completed after logging into MyThrivent for most products. For assistance with partial or complete withdrawals, call 800-847-4836.

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CloseLife Values Distribution

Call 800-847-4836 or contact your Financial Representative for assistance.

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CloseRollover to Thrivent Annuities

Process internal and external transfers, direct rollovers and internal conversion of retirement plan accounts with Thrivent Annuities.

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CloseRequired Minimum Distribution Request for Ongoing Scheduled Payments

Establish the Required Minimum Distribution payout or to make changes on an existing required minimum distribution payout.

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CloseThird Party Phone Authorization

Authorize Thrivent to release information via the telephone to someone who is not a contract owner/shareholder of your contract/account.

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CloseRequest for Arbitration

Submit a formal request for Arbitration. (After completing the Complaint, MDRP Appeal, MDRP Mediation processes.)

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CloseTelephone Transaction Authorization

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.

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CloseSubaccount Transfer Selection

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.

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CloseState Withholding for Annuity Payments

Use form 20017 to elect, change or opt out of state withholding for your Settlement Options and Immediate Annuity payouts.

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CloseBilling Change – Annuity & Life Insurance

Change billing for an insurance or annuity contract.

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CloseBilling Change – Send Bill to Special Payor

Authorize Thrivent to send your bill to a different person or business.

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CloseBilling Change – Set Up a Group Bill

Authorize Thrivent to set up your contract on a group bill.

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CloseClaims – Long-Term Care for all states except NY

File a claim for long-term care benefits. File an LTC claim easily over the phone by calling 1-800-847-4836 Say "directory" and enter extension 628-3166 to work with a claim coordinator. No forms required.

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CloseClaims – Long-Term Care for NY

File a claim for long-term care benefits. File an LTC claim easily over the phone by calling 1-800-847-4836 Say "directory" and enter extension 628-3166 to work with a claim coordinator. No forms required.

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CloseComplaint Questionnaire

Submit a formal complaint.

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CloseCertification of Trust

Verify trustee information when a contract is owned by a trust.

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CloseLife Premium Waiver/Disability Waiver Claim for Children (in ME, MA, NJ and NC)

Life Premium Waiver/Disability Waiver Claim for Children (in ME, MA, NJ and NC)

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CloseLife Premium Waiver/Disability Waiver Claim for Children (in all states except NY)

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.

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CloseLife Premium Waiver/Disability Waiver Claim for Children (in NY)

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.

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CloseStatement Household Group Authorization

Reduce the number of product statements received by annuity and/or mutual fund owners who share the same mailing address. One combined statement for all eligible accounts and contracts will be sent to the Statement Household Group each quarter. Review pages 1 and 2 carefully for more details. Provide all information and signatures indicated or your request may be delayed.

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CloseStatement Household Group Opt-Out Request

Request in writing to be removed from a Statement Household Group. Written requests are not required. For your convenience, you may call 800-THRIVENT (888-834-7428) and state your request to a customer service professional.

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CloseInterested Party Statement Authorization

Request to have copies of your annuity and/or mutual fund statements mailed to a person or entity you designate. Review page 1 for more details. Provide all information and signatures indicated or your request may be delayed.

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CloseRequest for Mediation

Submit a formal request for Mediation. (After completing the Complaint and MDRP Appeal processes.)

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CloseCancel 1035 Exchange From Thrivent – Annuity & Insurance

Cancel a request to 1035 exchange and/or transfer assets to an external company.

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CloseBeneficiary Change – Annuity & Life Insurance

Create a new Beneficiary Designation. Any information provided will replace any beneficiary designations currently on file.

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Close403(b) Contribution Agreement

Request to remit 403(b) contributions for purchase of an annuity contract or mutual fund shares.

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CloseDate of Birth or Gender Certification

Certify date of birth or gender.

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CloseBank Change – Direct Payment – Annuity & Insurance

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.

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CloseBank Change – Direct Deposits – Annuity & Insurance

Establish direct deposit of a systematic withdrawal to a bank account.

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CloseBank Change – Direct Payment – Thrivent Funds

Complete this form to establish, update or stop automatic withdrawals from a bank account to a Thrivent Funds account.

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CloseAutomated Payment of a Thrivent Product

Complete this form if you want to establish a systematic payout from a Thrivent Mutual Fund to pay the premium or loan repayment of another Thrivent product via the internal Electronic Payment System.

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Close403(b) & Qualified Plan Distribution Disclosure

This disclosure must be reviewed prior to submitting a distribution/redemption request for a 403(b). A signature confirming this review is required on the distribution/redemption request.

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CloseClaims – Disability Insurance

File a claim under your disability income contract. Complete it immediately upon disability. If claiming benefits under both a disability income and life contract, it is not necessary to complete a separate form for each benefit. Do not use this form if you live in NY. Instead see Claims – Disability Insurance under forms by category.

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CloseClaims – Disability Insurance (if you live in MA, ME, NC or NJ)

File a claim under your disability income contract. Complete it immediately upon disabillity. If claiming benefits under both a disability income and life contract, it is not necessary to complete a separate form for each benefit. Use this form only if you live in MA, ME, NC or NJ.

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CloseClaims – Disability Insurance (if you live in NY)

File a claim under your disability income contract. Complete it immediately upon disabillity. If claiming benefits under both a disability income and life contract, it is not necessary to complete a separate form for each benefit. Use this form only if you live in NY.

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CloseLife Premium Waiver/Disability Waiver Claim for Adults in all states except NY

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).

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CloseLife Premium Waiver/Disability Waiver Claim for Adults in ME, MA, NJ and NC

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).

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CloseLife Premium Waiver/Disability Waiver Claim for Adults in NY

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).

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CloseAutomatic Redemption Plan

Complete this form to establish ongoing systematic redemptions from a Thrivent Mutual Funds account.

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CloseOwnership Change – Thrivent Funds

Complete this form to move dollars from one account registration to another account registration in a Thrivent Funds account.
For accounts opened and managed on ThriventFunds.com, click here.

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CloseNon-Retirement Account Distribution – Mutual Funds

Complete this form to redeem dollars from a personal or business Thrivent Mutual Funds account.

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CloseEstablish Telephone Transactions

Complete this form to establish, change or stop telephone redemption, exchange or purchase options on a Thrivent Funds account.

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CloseBeneficiary Change – Mutual Funds

Complete this form to designate or update your beneficiary election on a Thrivent Funds retirement account.

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CloseVariable Products Allocation Change/Remittance Request

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.

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CloseWithholding Certificate for Pension or Annuity Payments

Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).

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CloseWithholding Certificate for Pension or Annuity Payments (in CT)

Residents of Connecticut, use Form CT W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).

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CloseW9 Taxpayer Identification

Certify the Tax Identification Number used for tax reporting.

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CloseMedicare Supplement Insurance

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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CloseHospital Confinement

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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CloseDistribution – Life Insurance

Call 800-847-4836 or contact your Financial Representative for assistance.

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CloseRetirement Account Distribution – Mutual Funds

Complete this form to redeem dollars from a Thrivent Mutual Funds retirement account.

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CloseCertification of Trust – Mutual Funds

Complete this form to provide information about a trust in a Thrivent Funds account.

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CloseTransfer/Rollover to Thrivent Funds

Complete this form to process internal and external transfers, direct rollovers and internal conversion of retirement plan accounts for Thrivent Funds.
For accounts opened and managed on ThriventFunds.com, you may use our on-line process. Log in to ThriventFunds.com and Add Rollover to existing IRA accounts, or open a new account.

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CloseThird Party Notification for Nonpayment of Premium (in all states except CT, ME, and NJ)

Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.

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CloseThird Party Notification for Nonpayment of Premium (in CT)

Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.

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CloseThird Party Notification for Nonpayment of Premium (in ME)

Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.

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CloseThird Party Notification for Nonpayment of Premium (in NJ)

Designate at least one person other than myself to receive notice of nonpayment of premium and, if required by the state where the contract was issued, that person will also receive notice of termination.

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CloseEasy Pay Enrollment

Establish automatic payment for annuity and insurance products from a bank or other financial institution.

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CloseBeneficiary Provisions

Provisions that are applicable to the beneficiary change completed on form 307B, Beneficiary Change.

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CloseSubaccount Transfer Selection – AdvisorFlex VA only

One-time, periodic transfer of funds between subaccounts on any of your AdvisorFlex variable product. Be sure to fill out this form accurately and completely or your request may be delayed.

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CloseTrusted Contact Person Designation

Adults age 60+ (or age 18+ who may have a mental or physical impairment that renders him or her unable to protect their own interests) can designate a trusted contact person who Thrivent can contact when there is suspected financial exploitation or failed attempts to reach the contract owner. Does not apply to health products.

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CloseAnnuity/Settlement Option Surrender Service Request

Used to request a complete/partial surrender or establish/change an Automatic Payout Option from a deferred/immediate annuity or settlement option.

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CloseExchange Request

Complete this form to exchange between accounts in Thrivent Mutual Funds with the same registration type and owner(s).

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CloseMutual Funds Interested Party Statement Authorization

Complete this form to add an interested party to your Thrivent Funds account to have statements sent to a third party.

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CloseNonqualified Account Transfer Request

Complete this form to initiate a redemption or transfer in kind from another company.

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ClosePlan Administration Online Access

Complete this form to request access to Plan Administration Online which will allow group Plan Administrators (SIMPLE, SEP, 403(b)) to submit payments electronically and manage participant rosters for their Thrivent Mutual Funds sponsored plans.

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CloseQualified Charitable Distribution

Complete this form to request a Qualified Charitable Distribution from a Thrivent Funds account.

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CloseRequired Minimum Distribution Request

Complete this form to establish required minimum distributions on a retirement account type or qualified plan in Thrivent Mutual Funds.

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Close403(b) Transfer/Exchange Request.

Complete this form to request transfer, exchange, rollover or conversion into or out of a Thrivent Mutual Funds 403(b) account.

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CloseAutomatic Exchange Plan

Complete this form to establish ongoing systematic exchanges between funds within the same registration type and owner(s).

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CloseDividends/Capital Gains Distribution

Complete this form to establish or update dividend/capital gain distribution or reinvestment options on a Thrivent Funds account.

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CloseEmployer/Employee Contribution Correction Request

Complete this form for employer or employee error corrections on contributions for a Thrivent Funds SEP, SIMPLE, and 403(b) account/Tax Sheltered Annuity.

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CloseExcess Removal of SIMPLE IRA Employee Contributions

Complete this form to remove excess employee contributions from a Thrivent Funds SIMPLE IRA account.

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CloseExcess Removal from Tradtional IRA/Roth IRA/SEP IRA/SARSEP IRA

Complete this form to remove excess contributions from a Traditional IRA/Roth IRA/SEP IRA/SARSEP IRA Thrivent Funds account.

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CloseBusiness Entity Information - Mutual Funds

Complete this form to provide authorized signers and beneficial owners for business entities on a Thrivent Funds account.

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CloseNon-Retirement Account Beneficiary Claim – Mutual Funds

Complete this form to move dollars inherited by the passing of the account owner to the beneficiary from a non-retirement account. Dollars can be moved to an account for the beneficiary or redeemed.

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CloseRetirement Account Beneficiary Claim – Mutual Funds

Complete this form to move dollars inherited by the passing of the account owner to the beneficiary from a retirement account. Dollars can be moved to an account for the beneficiary or redeemed.

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CloseBeneficiary Statement (All Options) Form 28E

Used by a beneficiary to indicate how they would like to receive their portion of a claim. This form includes distribution options. To determine if this form is needed, call 920-628-6312 or contact your Financial Representative for assistance.

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CloseBeneficiary Statement (Check or Direct Deposit Only) Form 28E CASH

Used by a beneficiary to indicate they would like to receive their portion of a claim via check or direct deposit. All other elections use the Beneficiary Statement (form 28E). To determine if this form is needed, call 920-628-6312 or contact your Financial Representative for assistance.

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CloseDeceased Beneficiary's Children Affidavit Form 5909A

Used when the beneficiary designation has a 'per stirpes' designation and a named or unnamed beneficiary is predeceased. This form defines who are the children are (sometimes referred to as 'issue') of a predeceased beneficiary with the per stirpes designation, for distribution of proceeds of that predeceased beneficiary's portion. To determine if this form is needed, call 920-628-6312 or contact your Financial Representative for assistance.

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CloseSurviving Beneficiary Affidavit Form 5909

Used to identify the person(s) in a beneficiary class designation such as children, born or adopted (step-children are not included), Grandchildren, Brothers/Sisters, Others such as nieces or nephews is named as beneficiary on a contract. Example – Beneficiary designation is 'Children, per stirpes'. To determine if this form is needed, call 920-628-6312 or contact your Financial Representative for assistance.

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CloseBusiness Entity Information - Annuity & Insurance 24838

Determine the authorized signer(s) and beneficial owners for Thrivent accounts/contracts owned by business entities.

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CloseDeceased Additional Health Information 34903

Deceased Additional Health Information

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Close Release of Information for Communication Portal 36001

Opt in to Communication Portal sharing by selecting the Communication Portal Preference within Communication Choices behind login on Thrivent.com. This preference is to authorize and acknowledge that any information that is sent through secure messaging can be seen by those who share the same email address when they login to Thrivent.com and access the communication portal.

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